Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy

Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy Monika Olga Jańczak, Marianna Izbaner, Victor Blüml, Emanuele Preti, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9321171/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective Disclosure of a personality disorder (PD) diagnosis is a clinically sensitive moment that may influence patients’ engagement with treatment, identity, and therapeutic relationships. Despite its importance, little is known about how patients themselves experience and interpret this process within specialized psychotherapies. Methods The present study explored how patients in Transference-Focused Psychotherapy (TFP) experience and make sense of receiving a PD diagnosis. Using a qualitative design, we analyzed written accounts from 17 patients engaged in TFP. Data were examined using reflexive thematic analysis. Results Participants described diagnostic disclosure as a complex and emotionally charged experience that evoked a wide range of reactions, including fear, relief, curiosity, and validation. Most reported an ambivalent relationship to the diagnosis, with its meaning evolving over time through therapeutic work and reflection. Six themes captured how patients understood and integrated the diagnosis into their therapeutic experience. For many, the diagnosis initially disrupted self-narratives and was experienced as an external verdict; however, over time it often became a framework that helped organize distress, support self-understanding, and guide therapeutic change. The relational context of disclosure emerged as central: when communicated within a supportive therapeutic relationship, the diagnosis was more often experienced as meaningful and containing rather than stigmatizing. Conclusion These findings suggest that diagnostic disclosure in PD treatment functions not merely as the communication of clinical information but as a relational and meaning-making process embedded in psychotherapy. Understanding patient experiences may help clinicians approach diagnostic discussions in ways that support engagement, reflection, and therapeutic collaboration. personality disorders diagnosis disclosure patient experience Transference-Focused Psychotherapy qualitative research thematic analysis Figures Figure 1 Practitioner Points Receiving a personality disorder diagnosis in psychotherapy may evoke mixed and changing emotional reactions (e.g., relief, fear, curiosity), highlighting the need for clinicians to approach diagnostic discussions with sensitivity and openness to dialogue. Diagnostic communication may be most helpful when framed as a collaborative and ongoing process, in which the clinician links the diagnosis to the patient’s personal history, symptoms, and therapeutic work rather than presenting it as a fixed label. Clinicians should be attentive to patients’ independent searches for diagnostic information, particularly online, and support them in contextualising potentially simplified or stigmatizing descriptions within a clinically grounded understanding. When discussing diagnoses associated with strong stigma (e.g., borderline or narcissistic PD), it may be helpful to emphasise the psychological suffering underlying these conditions, which can help protect the therapeutic alliance and promote reflection rather than shame or resistance. Introduction Over the past decades, the importance of integrating service users’ perspectives into mental health research has gained increasing recognition (Schleider, 2023 ), as has the value of qualitative research in psychotherapy (McLeod et al., 2021 ; Timulak & Keogh, 2026 ). Historically, individuals with lived or living experience—and their significant others—were treated primarily as passive subjects of research and clinical inquiry. More recently, however, a shift has occurred toward genuine collaboration between experts by profession and experts by experience (Ng et al., 2019 ; Renneberg et al., 2024). Within this shift, people with lived and living experience—including patients, relatives, and significant others—have highlighted key priorities for improving mental health treatment. Among these are questions about whether disclosure of a personality disorder (PD) diagnosis may exacerbate or alleviate stigma, understood as the internalization of negative stereotypes and societal attitudes toward mental illness, which may reduce help-seeking and increase social withdrawal (Begum-Meades et al., 2025 ; Masland & Sharp, 2025 ; Renneberg et al., 2024). Sociological and critical perspectives emphasize that diagnosis functions as a powerful act of naming embedded in asymmetrical relations of knowledge and authority (Foucault, 1973 ). Rather than merely describing an underlying condition, diagnostic categories shape how individuals understand themselves and how they are perceived by others, often becoming integrated into personal identities and self-narratives (Jutel, 2019 ). In this sense, disclosure of a diagnosis may represent a moment when externally defined clinical classifications intersect with lived experience, prompting processes of meaning-making and narrative reorganization. Recent critical accounts further suggest that diagnoses increasingly function not only as clinical tools but also as frameworks for identity and meaning, with the potential to both legitimize and constrain subjective experience (O’Sullivan, 2023). These processes may be particularly consequential in PDs, where diagnostic formulations directly concern enduring patterns of self-experience, interpersonal functioning, and relational expectations. Against this background, diagnosis disclosure in mental health is increasingly recognized as more than a neutral act of conveying clinical information. Qualitative research consistently indicates that being informed of a diagnosis may constitute a pivotal and emotionally salient experience, with consequences that extend beyond symptom understanding to encompass identity, self-concept, and engagement with care (Perkins et al., 2018 ). From the perspective of service users, receiving a diagnostic label can simultaneously offer relief, validation, and a framework for making sense of distress, while also evoking uncertainty, fear, or concerns related to stigma, social positioning, and being reduced to a clinical category (Rose, 2010 ; Lester et al., 2020 ). These findings suggest that the clinical significance of diagnosis disclosure lies not in the diagnostic label itself, but in how it is communicated, negotiated, and integrated into the therapeutic process. In PD treatment, communicating a diagnosis to the patient is a particularly sensitive clinical act. A diagnostic label can provide a shared framework for understanding, sharpen therapeutic focus, and guide treatment planning (Kendell & Jablensky, 2003 ; Sims et al., 2021 ). Importantly, its clinical value does not depend on correspondence to a discrete disease entity but on its ability to organize clinical understanding, inform decisions, and support collaborative treatment planning (Kendell & Jablensky, 2003 ). At the same time, diagnostic labels may reinforce stigma, evoke negative emotions, or become central to the patient’s identity (Finch & Mellen, 2025 ; Sims et al., 2021 ). Research shows that PD—particularly borderline (BPD) and narcissistic PD—is often perceived as a challenging diagnosis and may elicit unhelpful professional responses (Sulzer, 2015 ; James & Cowman, 2007 ; Chartonas et al., 2017 ). Service users frequently report inconsistent care, limited empathy toward self-harm, experiences of invalidation and powerlessness, and being perceived as manipulative (Ng et al., 2019 ; Rogers & Dunne, 2011 ). Conversely, research on collaborative and therapeutic assessment suggests that when diagnostic disclosure is approached as a joint reflective process, it can enhance patient autonomy, strengthen collaborative treatment planning, and increase access to meaningful diagnostic information (Finn, 2007 ; Finn et al., 2012 ). These contrasting perspectives highlight the clinical complexity of diagnosis disclosure in PD. More broadly, the impact of a diagnostic label depends not only on its content but also on who uses it, in what institutional context, and for what purpose (Werkhoven et al., 2022 ). Nevertheless, empirical research remains limited, particularly regarding how patients experience and interpret this process within specialized, evidence-based psychotherapies. Transference-Focused Psychotherapy (TFP) is one of four evidence-based, manualized treatments for personality disorders (PDs), alongside Mentalization-Based Therapy, Schema Therapy, and Dialectical Behavior Therapy (Storebø et al., 2020 ). In these approaches, diagnosis typically serves as an entry point to collaborative case formulation, supporting early alliance building and patient engagement in the therapeutic process (Katerud & Kongerslev, 2019; Fasbinder et al., 2019). In TFP, disclosure and discussion of the diagnosis are integral to establishing the treatment contract, clarifying therapeutic focus, and developing a shared understanding of treatment goals (Rentrop et al., 2025 ). Importantly, diagnostic disclosure in TFP is not a neutral transfer of clinical information but occurs within the therapeutic relationship, where meanings emerge through the analysis of transference and activated internal object relations (Caligor et al., 2018 ; Caligor et al., 2009 ). From this perspective, patients’ experience of receiving a diagnosis may depend not only on its content but also on two factors: the level of personality organization, which shapes defensive responses, and the quality of the transference relationship. However, no studies to date have examined how patients experience and interpret receiving and discussing their diagnosis, or how this process influences the therapeutic work. Addressing this gap is essential for understanding the role of diagnosis disclosure in PD treatment. Aims of the study This study aims to explore how patients with PDs experience and make sense of diagnosis disclosure in the context of Transference-Focused Psychotherapy. Using a qualitative design, we examined patients’ retrospective accounts of being informed about their diagnosis, focusing on the emotional, relational, and therapeutic meanings they attribute to this process. By centering on the patients’ perspectives, our goal was to deepen the understanding of how diagnosis disclosure may shape the therapeutic experience, including engagement, self-understanding, and the development of the therapeutic relationship. This study addresses a gap in empirical literature by investigating diagnosis disclosure not as a technical procedure, but as a clinically meaningful event embedded in a psychodynamic treatment process. The overarching research question guiding the analysis was: How do patients in Transference-Focused Psychotherapy experience and make meaning of PD diagnosis disclosure? Materials & Methods Study design and methodological framework The current study forms part of a larger qualitative project on patient experiences in Transference-Focused Psychotherapy (TFP) (ZZ, YY, submitted). As part of this project, we conducted approximately one-hour interviews with TFP patients, followed by written open-ended questions. The present analysis focuses on responses to one written question concerning the meaning of being informed about one’s diagnosis. This component of the project was not preregistered. A qualitative approach was used as the most appropriate for capturing the subjective, meaning-laden, and complex ways in which patients encounter and make sense of diagnosis. We adopted a constructivist–interpretive stance, assuming that knowledge is co-constructed through the interaction between participants’ narratives and researchers’ interpretive lenses. Participants articulate their lived experiences through language, while researchers bring their own positioning and theoretical commitments to the analytic process (Crotty, 1998 ; Savin-Baden & Howell-Major, 2013; Levitt, 2020 ). The data were analyzed using reflexive thematic analysis (Braun & Clarke, 2006 ; Braun et al., 2023 ), which allows for identifying and interpreting patterns of meaning in participants’ accounts while acknowledging the situated and reflective nature of knowledge creation. Participants and Procedure We used purposive sampling to enroll 17 patients with experience in Transference-Focused Psychotherapy (TFP): 11 in the advanced phase of treatment, 5 in the initial phase, and one who dropped out. Participants were recruited through their psychotherapists, all certified by the International Society of Transference-Focused Psychotherapy (ISTFP) and working in private outpatient practices in various cities across Poland. Therapists were identified through the national list of certified TFP practitioners (N = 72), all of whom were contacted and invited to inform their patients about the study. Of these, 40 agreed to assist with recruitment, 3 declined, and the remaining therapists did not respond. Because recruitment relied on therapist-mediated invitations and voluntary self-selection, the number of eligible patients who were approached or declined participation is unknown. To be eligible, participants had to be at least 18 years old and no older than 65, fluent in Polish, engaged in TFP treatment. Because the study aimed to examine how patients experience receiving a PD diagnosis, we excluded three participants who, according to their recollection, had not received any diagnosis (n = 2) or had received a non–PD diagnosis (anxiety–depressive disorder; n = 1). At the time of the interview, participants had been in therapy for an average of 3,14 years (range: 0.6–9.5 years). All patients had sessions twice weekly. The majority of the sample were female (76,5%) and had a Master’s degree (64,7%). In terms of relationship status, most of patients had a partner and were either married (17,6%) or in an informal relationship (52,9%). 23% of participants had children. The majority were employed full- or part-time (76%), lived in cities with over 200,000 residents (82,4%) and lived with a partner and/or children (41%). Seven participants (35%) reported a history of psychiatric hospitalization with an average number of hospitalization of 2 (range 1–3). The majority of participants (88%) were currently taking psychiatric medication, and 76% declared no chronic somatic illness. More detailed individual characteristics of the study participants are presented in Supplementary Table S1 . Information about participants’ diagnoses was based on their self-reports, that is, on how they recalled and understood the diagnosis communicated by their therapist. No independent diagnostic assessment was conducted, and the study did not have access to formal clinical records. Accordingly, the study refers to participants’ subjective understanding of their diagnosis rather than to independently verified PD diagnoses. Participants reported having received diagnoses of borderline PD (n = 5), narcissistic PD (n = 2), mixed PD (n = 5), histrionic (n = 1) and PD not otherwise specified (n = 3), as well as single case of comorbid depression in personality disorders PD (n = 1). Therapists were asked to inform only those patients for whom participation would not be emotionally burdensome, based on their clinical judgment and, if needed, supervisory consultation. To minimize potential effects on the therapeutic process, therapists’ role was limited to providing printed study information, including a link to the recruitment website. Interested patients contacted the research team independently. No independent assessments of adherence or competence were conducted; adherence to the TFP model was assumed based on therapist certification and confirmation that the patients had been treated using TFP. Each participant provided written informed consent prior to the study. As a token of appreciation for their time and contribution, each participant received a 200 PLN shopping voucher. The study protocol was reviewed and approved by the Ethics Committee of [anonymized for peer review], decision no. 04/02/2025. Data collection Data were collected between March and June 2025. As part of a questionnaire administered after questions concerning TFP psychotherapy duration and frequency, participants were asked whether they had been informed about their diagnosis at any stage of the therapeutic process (yes/no). If so, they were asked to specify the diagnosis in an open-ended format. Participants were then invited to respond in writing to the following open-ended question: “ What did it mean to you that you were (or were not) informed about your diagnosis? Please elaborate on your answer so that we can understand your experience as fully as possible .” Responses were provided in written form via the questionnaire. In total, 17 written statements were collected, with responses averaging 69.9 words (SD = 49.1; range: 3–192 words). Data analysis The qualitative data analysis followed the general procedures of reflexive thematic analysis as described by Braun and Clarke ( 2006 , 2021 , Braun et al., 2023 ). We adhered to the general six-phase process: (1) familiarization with the data, (2) coding, (3) generating initial themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. Initially, ES and MI familiarized themselves with the written accounts provided by patients and independently coded five randomly selected cases to calibrate the level of coding detail. After discussing their approaches, both independently coded the entire dataset and then met to examine areas of convergence and divergence. MI tended to code more explicitly (focusing primarily on the semantic level of the data, i.e., what participants directly articulated), whereas ES worked more implicitly (engaging more strongly with latent meanings and interpretative patterns underlying the data; Braun et al., 2023 ). These complementary perspectives enriched the process, and both sets of codes formed the foundation for theme development. In the next phase, each researcher generated preliminary themes separately, after which joint discussions were held to establish a shared thematic structure. One theme (related to diagnosis as a stimulus for personal development and as connected to identity) was found to lack sufficient precision. Thus, we revisited the relevant codes and reformulated the theme. The final set of themes and corresponding codes was discussed with MOJ, whose feedback contributed to refining the thematic structure. Through this discussion, the research team further developed and clarified the thematic interpretation, and the themes reported in this article represent the final analytic account produced by the team. All coding was conducted manually using Microsoft Excel spreadsheets, which enabled systematic organization and comparison of codes and themes across researchers. The data were collected and analyzed in Polish, and the final report was prepared in English, with careful attention to preserving participants’ original meanings while ensuring accessibility for an international readership. Trustworthiness To ensure trustworthiness, we implemented strategies aligned with reflexive thematic analysis and reported them transparently. First, we engaged in prolonged immersion in the dataset through iterative reading and re-reading of the full corpus. Second, we used analyst triangulation understood as dialogic and reflexive collaboration: YY and XX calibrated the granularity of coding on an initial random subset, independently coded the full dataset, and then met to examine convergences and productive divergences. The complementarity of more explicit (XX) and more implicit (YY) coding enhanced sensitivity to both manifest and latent meanings in participants’ accounts. Team discussions iteratively linked developing interpretations back to the raw data and, where appropriate, situated them within relevant clinical contexts. Third, we maintained an audit trail comprising dated coding spreadsheets (Excel), code lists, thematic maps, and decision logs. For each theme, we preserved a transparent chain of evidence (theme → codes → illustrative extracts), provided in the Supplementary File S1. Given that all team members were trained within a psychodynamic tradition, we treated this shared positioning as both a resource and a potential constraint. We documented our stance through brief reflexive memos, considered alternative readings, and guarded against confirmation bias. Consistent with the epistemology of reflexive thematic analysis, we did not compute inter-coder reliability indices; instead, we prioritized interpretative coherence, transparency of the analytic decision trail, and resonance between themes and data excerpts. Research team and reflexivity We considered the positionality of the research team as an integral element of the analytic process. The team responsible for data analysis and preparation of the report consisted of three members, all affiliated with the same institution but representing different professional trajectories within psychology—each grounded in a psychodynamic orientation. ZZ is a psychodynamic psychotherapist and supervisor, trained in Transference-Focused Psychotherapy, and a researcher in clinical psychology and psychotherapy. MI is a PhD student in clinical psychology who is training as a psychodynamic therapist (MBT) but has not been trained in TFP. ZZ and XX drew more heavily on their clinical experience in interpreting participants’ accounts. YY is trained in psychodynamic psychotherapy (not TFP) but currently identifies primarily as a researcher in clinical psychology, specializing in qualitative methodologies. This brought a focus on analytic rigor and sensitivity to language while minimizing potential therapeutic allegiance bias. Importantly, only XX and YY had a direct access to the data and conducted the thematic analysis, with ZZ providing supervisory input on the emerging themes and interpretations. At the same time, the fact that all team members shared a psychodynamic background may have sensitized us to particular aspects of the data while limiting engagement with alternative perspectives. Results In response to the research question—how patients undergoing Transference-Focused Psychotherapy experience the communication of a PD diagnosis, what the disclosure or possibility of diagnostic disclosure means to them, and what meanings they attribute to diagnosis within psychotherapy—we identified six themes that structured patients’ experiences of diagnostic communication (see Fig. 1 ). [Figure 1 here] Theme 1: The Diagnosis as Verdict The initial diagnostic encounter could function as a rupture in self-narratives, triggering cognitive dissonance between internalised self-concepts and clinical categorisation. Rather than offering clarification, the diagnosis was experienced as an ontological threat—a pronouncement that crystallised participants' sense of fundamental difference from others while activating culturally embedded stigma schemas. We interpret these accounts as indicating that diagnosis functioned not merely as clinical information, but as a symbolic verdict that reconfigured participants' self-understanding in relation to socially available meanings of PD. Confronting prior beliefs about oneself with the diagnosis led to significant cognitive dissonance for some participants. A 42-year-old woman stated: "When I heard the diagnosis: narcissistic PD, I was shocked (...) It took me a long time getting used to the diagnosis" (207). Prevailing knowledge about the diagnosis, shaped by cultural narratives and clinical experience, determined how it was perceived. Participants also referred to the timing of receiving the diagnosis within therapy, which formed part of how they retrospectively made sense of the diagnostic disclosure. A 24-year-old woman with borderline PD explained: “I received the diagnosis only after about two years of therapy. It was hard for me to hear because I know people with BPD and the suffering it involves, and I also know that prognosis for recovery isn't encouraging" (203). Regardless of the clinical timing of disclosure, participants’ recollections of when and how the diagnosis was communicated shaped their subjective experience of the diagnostic process. The diagnosis confronted pre-existing self-beliefs and generated existential anxiety, sometimes experienced as an exposure of inherent difference marked by stigma. A 25-year-old patient with narcissistic PD felt: "I was an outsider—someone different from the rest of society, which could have deepened my tendency towards isolation and temporarily lowered my self-esteem" (03). One participant admitted: "I couldn't accept it and treated it as a verdict" (207). Thus, hearing the diagnosis sometimes solidified entrenched negative beliefs about oneself, as in the case of mentioned patients with narcissistic PD. Theme 2: Diagnosis as Frame of Reference Beyond its descriptive function, the diagnosis operated as a pragmatic tool that transformed passive suffering into actionable problems. Participants described how diagnostic framing enabled treatment navigation, structured therapeutic goals, and facilitated a shift from bewilderment to agency—positioning the diagnosis not merely as knowledge about the self, but as knowledge for action upon the self. Hearing the diagnosis allowed naming what caused suffering and situating it within a broader system of meanings, bringing relief and a sense of control. One participant described: "It reinforced my belief that my difficulties are not due to recurring depression alone but partly the result of how I perceive the world and others" (MJ001/201). A 25-year-old participant explained: "It gave me the opportunity to gather information about these disorders—I read extensively, and when I recognised my difficulties in this material, it became easier to find ways to deal with them and function more normally." Receiving a diagnosis enabled patients to position themselves socially and legitimize their suffering in the eyes of others. A 47-year-old woman highlighted: "It allowed me to place myself within a system of behaviours and experiences (...) It became easier to define myself in relation to others" (204). A participant with borderline PD stated: I really wanted to know if there is something wrong with me, or if I'm just exaggerating and looking for a problem, to name it somehow. It gave me relief and a bit more understanding of myself; I also had something to tell my parents so that they would acknowledge my problems as real (208). Participants reported that a key aspect of hearing the diagnosis was the possibility of better self-understanding. While this process was painful for some due to revealing a difficult truth, it also opened the path to more constructive thinking about oneself. A 25-year-old participant noted: "I could anchor myself in who I am beyond what I already know about myself. My self-awareness grew; I could observe myself and my behaviour more clearly" (03). The diagnosis served as a means to build a coherent sense of self within the arc of one's life history. A 49-year-old woman with histrionic PD stated: I think of it as a tool that can help me see certain patterns—like a strong need to be noticed, emotional expressiveness, dependence on others' approval—and start examining where this comes from and how to deal with it in a healthy way. PDs are difficult, but they're not fixed and unchangeable. Every PD is a story about something difficult that happened in childhood (304). Theme 3: The Relational Context of Diagnostic Disclosure Patients experienced the diagnosis as a relationally situated event, emphasising the importance of the therapeutic relationship and the therapist as a supportive figure in adapting to the new information. The context of diagnostic delivery—particularly the quality of the therapeutic alliance—shaped whether the diagnosis was experienced as helpful or threatening. A 30-year-old woman with mixed PDs stated: "It gave me a sense of assurance and safety; if something is named, it can be identified and worked with, mitigated" (01). A 25-year-old patient admitted: "I felt relief, as it was another voice saying that I am suffering from a PD (from the specialist)" (03). Patients stressed the significance of the therapeutic relationship as a condition enabling acceptance of the diagnosis. One participant explained: "This mattered a lot to me because I regarded my therapist as an authority, someone who tells me the truth and knows about this" (01). A 22-year-old woman with borderline PD said: "Fortunately I came to my therapist, who supported me and explained many things, assuring me that her role is to help" (208). One participant shared: "My therapist reassured me that in my case the disorder is not highly advanced, and I have good chances for normal functioning; the therapy I am in gives me these chances" (203). A 46-year-old man with narcissistic PD highlighted: "Simply naming the disorder wasn't decisive; what mattered in the early years of therapy was understanding that my therapist understands what I am dealing with" (303). Theme 4: Digital (Dis)information and Diagnostic Stigma Participants' engagement with online diagnostic content revealed a critical gap between clinical and popular understandings of PDs. The internet emerged as an unregulated interpretive space where diagnostic labels became detached from therapeutic context, exposing patients to catastrophising narratives and stigmatising discourse that undermined the containing function of the therapeutic relationship. A 40-year-old woman with narcissistic PD stated: "I read about it on the internet; the internet, as always, showed me dreadful scenarios; the reality turned out to be easier" (MJ002/202). Another patient shared: "There is a risk of becoming obsessed with this topic and blaming myself for all the negative things so prevalent on the internet" (01). The effect of self-directed information seeking heightened anxiety and significantly worsened self-esteem for some patients. One patient with borderline PD underscored: "At the same time, such a diagnosis was difficult for me because it involves stigma; I started reading a lot of simplifications and untruths about PDs on the internet, and I was frightened; I felt that I might know what is wrong with me, but I cannot get help, I began to think I am a monster. After reading various forums about how people with such a diagnosis destroy others, that one should run away from them, etc., my suicidal thoughts intensified" (208). While the therapeutic context can provide frameworks for communicating the diagnosis in a psychologically safe way, the internet—especially social media—constitutes a space where patients become exposed and vulnerable to destabilising information. Theme 5: Diagnosis as Tool for Change Building on the diagnostic frame described in Theme 2, participants articulated how diagnosis moved beyond meaning-making to actively shape decisions, actions, and engagement in the therapeutic process. The diagnosis functioned as a practical guide in the recovery process, helping patients choose appropriate forms of therapy and enabling a shift from helplessness to agency and hope for change. The diagnosis often functioned as an indicator of what kind of help to seek. A 27-year-old patient with borderline PD noted: "I already knew my diagnosis (MMPI + SCID) and, based on it, I was looking for therapy" (205). A 47-year-old woman emphasised: "It also justified the need to start psychotherapy" (204). A 36-year-old patient admitted that the diagnosis developed during therapy redirected his treatment: "It prompted me, encouraged by the psychotherapist, to move away from pharmacological treatment" (04). One patient with borderline PD noted that the diagnosis marked the first step towards acknowledging the need for help: "Somehow it helped me allow myself to feel that it is hard for me and to agree to help" (208). The diagnosis was experienced as helpful in engaging with therapy through the structure it afforded. A 40-year-old woman with narcissistic PD explained: It also helped me understand what to think about in terms of psychotherapy, what to talk about; even what I read online helped me know what to say in therapy, which threads to bring in, because at the start I didn't know what to talk about (MJ002/202). A 46-year-old man with narcissistic PD shared: "Moreover, I think it was important at different stages to revisit the diagnosis and understand through its lens what I am doing or what is happening to me" (303). From patients' perspectives, the diagnosis brought agency over illness. A 31-year-old woman noted: "It allowed me to look at myself differently, to see that much depends on me, not just that I am ill" (MJ001/201). A patient with borderline PD highlighted: "It comforts me to know what is wrong with me because I can understand myself better and work on changing behaviours I don't like and that hinder my functioning" (206). Theme 6: Living with the Diagnosis Over Time The subjective experience of diagnosis was fundamentally temporal, with initial distress gradually yielding to more nuanced and integrated understandings. This temporality reflects participants' retrospective narrative reconstructions of change unfolding within psychotherapy. Participants reworked the diagnosis from an external imposition into a flexible cognitive tool—one that could be held, examined, and selectively incorporated into identity without becoming identity-defining. Initially difficult to accept, the diagnosis became workable as it was given meaning within the context of personal experiences through psychotherapy. A 46-year-old man with narcissistic PD stated: "In the end, I think what mattered in this process was not only understanding the diagnosis but also accepting it" (303). A 49-year-old woman with histrionic PD emphasized: "The diagnosis does not define who I am" (304). Some patients noted that the formal diagnostic process may be imperfect or erroneous. A 27-year-old patient recalled: Since I was 14, I have been given various diagnoses—anorexia, bulimia, depression, obsessive-compulsive disorder. No medications helped, and I felt bad. Only when I started therapy around 21 did I hear the borderline diagnosis, and I agree with that now (206). For most patients, the relationship to the diagnosis shifted from negative to positive. One participant reflected: "Ultimately, having received a diagnosis was painful but helpful and necessary, and long term it gave more than it momentarily hindered me. It gave significance and truth to my suffering" (208). However, not all patients shared this view. One patient with mixed PD stated: “After some time, however, the diagnosis became a stigma for me because I probably read too much about it on the internet” (210). At the same time, ambivalence remained. A 42-year-old woman with narcissistic PD acknowledged: To this day I think of myself as a person with a disorder... at the same time I think that without hearing the diagnosis it would have been hard for me to feel the gravity of my problem, and I might still downplay my state and thus not strive to change my unsatisfactory situation (207). Overall, the experience of hearing the diagnosis appeared to have potential for greater integration despite the difficult emotions it provoked. Discussion This study explored how patients in Transference-Focused Psychotherapy experience and make sense of receiving a PD diagnosis, with particular attention to how it shapes engagement in therapy, self-understanding, and the therapeutic relationship. In general, being informed about the diagnosis was described as a complex and emotionally charged experience, evoking a wide range of reactions, including surprise, fear, relief, gratitude, curiosity, and at times even joy. Most participants reported an ambivalent relationship to the diagnosis, with its meaning evolving over time through therapeutic work, new information, and personal reflection. It must be noted though, that within the TFP framework, disclosure of a PD diagnosis can be understood as a relational intervention that activates dominant object-relational dyads (Caligor et al., 2018 ; Felici et al., 2025 ). In this context, the quality of the transference relationship may shape how the diagnosis is experienced and integrated by the patient. The findings should also be considered in light of the study sample: participation was voluntary and therapists invited patients for whom participation was unlikely to be emotionally burdensome. As a result, the sample may primarily reflect the perspectives of relatively better-functioning patients engaged in TFP. Overall, six themes were identified that captured different aspects of how patients understood and integrated the diagnosis into their therapeutic experience. Our findings indicate that the experience of diagnosis was fundamentally relational (Theme 3: The Relational Context of Diagnostic Disclosure ). Importantly, in patient’s experience, the way in which the diagnosis was communicated appeared to shape how it was subsequently understood and integrated. When conveyed within the therapeutic relationship, the diagnosis was more often described as tolerable, meaningful, and integrated into an ongoing process of change, in contrast to diagnoses encountered in isolation, such as through self-directed online searches. Nevertheless, for many participants, the initial diagnostic encounter disrupted their self-narratives and created cognitive dissonance between long-held self-concepts and the clinical categorization (Theme 1: The Diagnosis as Verdict ) . Rather than providing clarity, the diagnosis was experienced as an external verdict that intensified feelings of difference, activated stigma-related meanings, and temporarily undermined self-esteem. Importantly, this pattern was observed among participants who reported receiving different diagnoses (e.g., borderline and narcissistic personality disorder), as these themes appeared across many narratives. These accounts suggest that diagnostic disclosure may function not only as clinical information but also as a symbolic event with the potential to reshape identity, sometimes in constraining ways. Two potential clinical factors may contribute to the extent to which patients experience the diagnosis as threatening or destabilizing. First, patients functioning at different levels of personality organization, characterized by different predominant defense mechanisms, may respond to diagnostic disclosure in markedly different ways. More primitive defenses based on splitting and projection may increase the likelihood that the diagnosis will be experienced as a threat, criticism, or external attack on the self (Clarkin et al., 2007 ). Second, the configuration of the transference relationship may substantially influence how the diagnosis is experienced and interpreted. For example, patients with more paranoid or narcissistic features may be more likely to experience the diagnosis as a source of shame or threat, whereas patients with more neurotic personality may respond in potentially less persecutory way. Future studies should address this heterogeneity and examine whether the experience of diagnosis disclosure differs across specific PD diagnoses. As therapy progressed, participants came to experience the diagnosis as more than a descriptive label; it functioned as a practical framework that helped translate diffuse distress into identifiable and workable therapeutic targets (Theme 2: Diagnosis as Frame of Reference). At the same time, the diagnosis served as a reference point for therapeutic work, helping to organize and guide efforts toward change (Theme 5: Diagnosis as Tool for Change ). For many, naming their difficulties ultimately brought relief, greater self-understanding, and a sense of agency, supporting a shift from confusion to more goal-directed engagement in treatment. However, even over time, some participants struggled to move beyond the diagnosis — becoming overly absorbed in diagnostic information or increasingly defining themselves through the lens of having a disorder. Rather than serving as a framework for understanding, the diagnosis became a fixed lens through which the self was perceived. This could also be understood as perpetuating a pattern of seeing oneself primarily as the victim of “bad” parental objects and past relational experiences. This suggests that experiencing diagnosis may sustain a more passive or victim-oriented representation of the self. From a TFP perspective, such reactions may reflect the activation of internal object relations and defensive patterns that organize the patient’s experience of the diagnosis within the transference (Caligor et al., 2018 ; Caligor et al., 2009 ). Overall, our findings align with well-established recommendations that patients with PDs should be actively involved in collaborative discussions about diagnosis and treatment, including psychoeducation tailored to the disorder (Keepers et al., 2024 ). Within Transference-Focused Psychotherapy, the explicit sharing and ongoing discussion of the diagnosis is strongly emphasized as a foundation for treatment planning, contracting, and the therapeutic focus. At the same time, our results resonate with broader concerns raised by individuals with lived experience, who have highlighted that the impact of diagnostic disclosure depends critically on the conditions under which it occurs and the meanings that patients subsequently attribute to the label (Renneberg et al., 2024). These concerns include how diagnostic labels may shape or transform a person’s identity over the course of treatment, the potential for stigma associated with PD diagnoses, and the influence of both the manner of disclosure and the quality of subsequent treatment. Importantly, in psychodynamic treatment these processes unfold not only at an explicit, reflective level but also within the transference relationship, where the diagnosis may become embedded in ongoing relational patterns and unconscious meanings that shape how it is experienced and integrated over time. Although a diagnosis of PD may initially be experienced as stigmatizing, participants’ accounts suggest that this experience can evolve over time and that stigma is not a fixed or inevitable outcome (Theme 4. Digital (Dis)information and Diagnostic Stigma ) . Our findings indicate that stigma may be mitigated when diagnostic information is communicated within a reflective therapeutic relationship and accompanied by collaborative discussion and psychoeducation. Studies drawing on lived experience perspectives showed that when clearly communicated, contextualised, and linked to meaningful treatment options, receiving a PD diagnosis has been described as a turning point that supports insight, enhances patient autonomy, facilitates access to appropriate interventions, and fosters hope for recovery (Lester et al., 2020 ; Tedesco et al., 2024 ). In contrast, participants’ narratives point to the potentially iatrogenic effects of seeking diagnostic information independently, particularly through online sources, where oversimplified, decontextualized, or pathologizing portrayals of PDs may intensify fear, self-stigmatization, or diagnostic foreclosure (Monteith et al., 2024 ). Our findings also suggest that patients do not remain passive recipients of a PD diagnosis; rather, they actively engage with it, interpret it, and attempt to integrate it into their understanding of themselves and their lives (Theme 6: Living with the Diagnosis Over Time). The present study therefore shifts the focus from whether a diagnosis should be disclosed to how patients work with diagnostic information—how they negotiate its meanings, resist or reinterpret stigmatizing aspects, and use the diagnosis as a resource for self-understanding and change within and beyond the therapeutic context. While these themes emerged independently and no single participant presented a complete narrative encompassing all stages, they may be seen as a temporal process of experiencing diagnosis: initially as a verdict—difficult to accept and disrupting one's sense of self and others, particularly when explored independently online; subsequently as a framework enabling self-definition and motivating therapeutic engagement; and ultimately as an integrated experience transformed through reflection and meaning-making. The therapeutic relationship appears as a central element present throughout all stages, functioning as a holding environment that allows various emotions to be experienced safely. Consistent with work on collaborative diagnosis (Hackmann et al., 2019 ), our findings suggest that even when diagnostic disclosure concerns the communication of a diagnostic label rather than the diagnostic process itself, patients attribute particular importance to the relational context as shaping whether the consequences of diagnosis are experienced as supportive or harmful. Implications for Practice The present findings underscore that patients’ experiences of diagnosis are highly individual, dynamic, and subject to change over time. Rather than offering prescriptive rules about what clinicians should or should not do, the results highlight key areas of sensitivity and clinical attunement. First, diagnostic communication may be most helpful when approached as a collaborative process rather than a one-sided act of disclosure. In TFP, although the clinician holds responsibility for establishing the diagnosis, it is important to discuss it with the patient and link the diagnostic formulation to the patient’s personal history and the function of their symptoms, which may reduce shame and support a more reflective understanding of their difficulties. Rather than avoiding diagnostic disclosure for fear of causing offense, clinicians should recognize that such information may evoke strong emotions and should be addressed through ongoing dialogue about its meaning for the patient. Second, working with a diagnosis should be understood as an ongoing process rather than a single event; clinicians may benefit from revisiting the diagnosis over time and exploring how its meaning and relevance evolve in the course of treatment. Particular clinical attention should be paid to patients’ independent searches for diagnostic information, especially online. When communicating a diagnosis, it may be helpful to explicitly acknowledge that internet-based descriptions can be simplified, distorted, or stigmatizing, and to support patients in maintaining a clinically grounded understanding of what the diagnosis means in the context of their own experience and therapeutic work. Therapists should be aware of the cultural context associated with the diagnosis and actively explore what meaning the diagnosis holds for the patient, as patients may have pre-existing beliefs shaped not only by information obtained online, but also by discourse created within their own socio-cultural environment. In the many cultural contexts, diagnoses of narcissistic and borderline PDs carry particularly heavy stigma. When communicating such diagnoses, clinicians should emphasize the psychological suffering inherent in these conditions, framing them as sources of distress rather than character flaws. This approach helps ensure that the diagnosis serves to strengthen the therapeutic alliance rather than undermine it, fostering collaboration and hope instead of shame and resistance. Limitations This study has a few limitations that need to be acknowledged. A key limitation of the study concerns the sampling procedure. Participation was voluntary and based on self-selection, with patients deciding independently whether to take part. In addition, for ethical reasons therapists were asked to inform only those patients for whom participation would not be emotionally burdensome or potentially disruptive to the therapeutic process. Moreover, in Poland TFP is currently practiced primarily by therapists working in private practice, which means that patients receiving this treatment are typically individuals who are functioning well enough to afford psychotherapy. As a result, the sample likely overrepresents individuals who were willing and able to reflect on their experiences in therapy, while patients experiencing more negative or paranoid transeference, greater distress, disengagement, or more general negative views of TFP may be underrepresented. Accordingly, the findings should be understood as capturing the perspectives of patients who chose to articulate their experiences, rather than representing the full range of possible responses to TFP. Another limitation is that the study relies exclusively on patients’ retrospective accounts of how the nosological diagnosis was discussed during TFP. We do not have access to independent or objective information about the diagnostic communication itself; thus, the findings reflect patients’ subjective experiences and interpretations rather than verified descriptions of how the diagnosis was conveyed in therapy. Third, all members of the research team were trained within a psychodynamic framework. While this shared orientation facilitated interpretive coherence and provided a meaningful basis for studying the communication of diagnosis in TFP, it may also have narrowed the analytic lens and limited engagement with alternative perspectives. The dual roles of the researchers as clinicians and analysts further shaped the interpretation of patient accounts, enriching the analysis with clinical sensitivity but also carrying the risk of projecting therapeutic assumptions onto the data. To mitigate this, we maintained a continuous reflective stance throughout the analytic process. Fourth, the analysis was conducted in Polish, with findings reported in English. Although care was taken to preserve semantic integrity in translation, subtle shifts in meaning cannot be ruled out. The use of Microsoft Excel as the main tool for coding ensured transparency but offered fewer functionalities than specialized qualitative software; however, this solution was adequate given the modest size of the dataset. Finally, the findings are situated within the Polish psychotherapeutic context, where practices of communicating nosological diagnoses have changed considerably in the past decade. This specificity may limit the transferability of the results to contexts in which diagnostic practices differ. At the same time, it does not alter the central point we wish to emphasize—that whether or not a diagnosis is communicated constitutes a significant element of the therapeutic relationship and extends beyond the therapeutic context, becoming part of the patient’s lived reality and its ongoing transformations. Declarations Disclosure Statement The authors declare no financial competing interests. Some authors (A1, A3, A4, blinded for review) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest. Competing Interests The authors declare no financial competing interests. Some authors (MOJ, VB, EP) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest. Funding This research was funded by the [blinded for review], project no. 140/04/POB5/0005, awarded to Author 1. Author Contribution The authors declare no financial competing interests. Some authors (A1, A3, A4, blinded for review) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest. Data Availability Due to the sensitive and potentially identifiable nature of the interview material, the full qualitative dataset (i.e., interview transcripts) cannot be made publicly available. Sharing the complete transcripts could compromise participant confidentiality. To enhance transparency of the analytic process, the Appendix provides the coding framework underlying each theme, including the associated codes and illustrative participant quotations drawn from the data. References Begum-Meades, R., Feilder, S., & Crawford, M. J. (2025). Prevalence and Correlates of Self-Stigma in Personality Disorder Compared With Anxiety and Depression: A National Cross-Sectional Survey. Personality and mental health , 19 (2), e70011. https://doi.org/10.1002/pmh.70011 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology , 3 (2), 77–101. https://doi.org/10.1191/1478088706qp063oa Braun, V., & Clarke, V. (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. Counselling and Psychotherapy Research , 21 (1), 37–47. https://doi.org/10.1002/capr.12360 Braun, V., Clarke, V., Hayfield, N., Davey, L., & Jenkinson, E. (2023). Doing reflexive thematic analysis. In S. Bager-Charleson, & A. McBeath (Eds.), Supporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research (pp. 19–38). Springer International Publishing. Caligor, E., Diamond, D., Yeomans, F. E., & Kernberg, O. F. (2009). The interpretive process in the psychoanalytic psychotherapy of borderline personality pathology. Journal of the American Psychoanalytic Association , 57 (2), 271–301. https://doi.org/10.1177/0003065109336183 Caligor, E., Kernberg, O. F., Clarkin, J. F., & Yeomans, F. E. (2018). Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning (1st ed.). American Psychiatric Publishing Inc. Chartonas, D., Kyratsous, M., Dracass, S., Lee, T., & Bhui, K. (2017). PD: Still the patients psychiatrists dislike? BJPsych Bulletin , 41 (1), 12–17. https://doi.org/10.1192/pb.bp.115.053249 Clarke, V., & Braun, V. (2017). Thematic analysis. The Journal of Positive Psychology , 12 (3), 297–298. https://doi.org/10.1080/17439760.2016.1262613 Clarkin, J. F., Lenzenweger, M. F., Yeomans, F., Levy, K. N., & Kernberg, O. F. (2007). An object relations model of borderline pathology. Journal of personality disorders , 21 (5), 474–499. https://doi.org/10.1521/pedi.2007.21.5.474 Crotty, M. (1998). The Foundations of Social Research: Meaning and Perspective in the Research Process . SAGE Publications Inc. Fassbinder, E., Wilde, O. B. D., & Arntz, A. (2019). Case Formulation in Schema Therapy: Working with the Mode Model. In U. Kramer (Ed.), Case Formulation for Personality Disorders: Tailoring Psychotherapy to the Individual Client (pp. 77–94). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-813521-1.00005-9 Felici, C., Preti, E., Madeddu, F., & Kramer, U. (2025). In the process of transference-focused psychotherapy: Application of an observer rating grid for object relations dyads on a psychotherapy session. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy. Advance online publication. https://doi.org/10.1007/s10879-025-09710-9 Finch, E. F., & Mellen, E. J. (2025). Labeled, Criticized, Looked Down On: Characterizing the Stigma of Narcissistic Personality Disorder. Personality and mental health , 19 (2), e70015. https://doi.org/10.1002/pmh.70015 Finn, S. E. (2007). In our clients’ shoes: Theory and techniques of therapeutic assessment . Lawrence Erlbaum Associates. Finn, S. E., Fischer, C. T., & Handler, L. (2012). Collaborative/therapeutic assessment: Basic concepts, history, and research. In S. E. Finn, C. T. Fischer, & L. Handler (Eds.), Collaborative/therapeutic assessment: A casebook and guide (pp. 1–24). John Wiley & Sons, Inc. Foucault, M. (1973). The birth of the clinic: An archaeology of medical perception (A. M. Sheridan Smith, Trans) . Routledge. (Original work published 1963). Hackmann, C., Wilson, J., Perkins, A., & Zeilig, H. (2019). Collaborative diagnosis between clinician and patient: Why to do it and what to consider. BJPsych Advances , 25 (4), 214–222. https://doi.org/10.1192/bja.2019.6 James, P. D., & Cowman, S. (2007). Psychiatric nurses’ knowledge, experience and attitudes towards clients with borderline PD. Journal of Psychiatric and Mental Health Nursing , 14 (7), 670–678. https://doi.org/10.1111/j.1365-2850.2007.01156.x ZZ, YY (submitted). I’ve Built a Good Life for Myself: A Qualitative Study of Patient-Perceived Change in Transference-Focused Psychotherapy. Jutel, A. (2019). Putting a name to it: Diagnosis in contemporary society (2nd ed.). Johns Hopkins University. Karterud, S., & Kongerslev, M. T. (2019). Case formulations in mentalization-based treatment (MBT) for patients with borderline personality disorder. In U. Kramer (Ed.), Case formulation for personality disorders: Tailoring psychotherapy to the individual client (pp. 41–60). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-813521-1.00003-5 Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. American Journal of Psychiatry , 160 (1), 4–12. https://doi.org/10.1176/appi.ajp.160.1.4 Keepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Choi-Kain, L., Nelson, K. J., Oldham, J. M., Sharp, C., Degenhardt, A., Fochtmann, L. J., Oldham, J. M., Hong, S. H., & Medicus, J. (2024). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. The American journal of psychiatry , 181 (11), 1024–1028. https://doi.org/10.1176/appi.ajp.24181010 Lester, R., Prescott, L., McCormack, M., Sampson, M., & North West Boroughs Healthcare NHS Foundation Trust. (2020). Service users’ experiences of receiving a diagnosis of borderline PD: A systematic review. Personality and Mental Health , 14 (4), 263–283. https://doi.org/10.1002/pmh.1478 Levitt, H. M. (2020). Reporting standards for qualitative research in psychology: What are they, and why do we need them? In H. M. Levitt, Reporting qualitative research in psychology: How to meet APA Style Journal Article Reporting Standards (Revised Edition, pp. 3–18). American Psychological Association. https://doi.org/10.1037/0000179-001 Masland, S. R., & Sharp, C. (2025). Advancing the Science and Reduction of Personality Disorders Stigma: Introduction to a Special Issue of Personality and Mental Health. Personality and mental health , 19 (4), e70044. https://doi.org/10.1002/pmh.70044 McLeod, J., Stiles, W. B., & Levitt, H. M. (2021). Qualitative research: Contributions to psychotherapy practice, theory, and policy. In Bergin and Garfield’s handbook of psychotherapy and behavior change: 50th anniversary edition, (7th ed.) (pp. 351–384). John Wiley & Sons, Inc. Monteith, S., Glenn, T., Geddes, J. R., Whybrow, P. C., Achtyes, E. D., & Bauer, M. (2024). Implications of Online Self-Diagnosis in Psychiatry. Pharmacopsychiatry , 57 (2), 45–52. https://doi.org/10.1055/a-2268-5441 Ng, F. Y., Townsend, M. L., Miller, C. E., Jewell, M., & Grenyer, B. F. S. (2019). The lived experience of recovery in borderline PD: A qualitative study. Borderline PD and Emotion Dysregulation, 6, Article 10. https://doi.org/10.1186/s40479-019-0100-1 O’Sullivan, S. (2025). Wiek diagnozy: Jak obsesja na punkcie zdrowia czyni nas bardziej chorymi [The age of diagnosis: Sickness, health and why medicine has gone too far] . Znak Literanova. Perkins, A., Ridler, J., Browes, D., Peryer, G., Notley, C., & Hackmann, C. (2018). Experiencing mental health diagnosis: A systematic review of service user, clinician, and carer perspectives across clinical settings. The Lancet Psychiatry , 5 (9), 747–764. https://doi.org/10.1016/S2215-0366(18)30095-6 Renneberg, B., Hutsebaut, J., Berens, A., De Panfilis, C., Bertsch, K., Kaera, A., Kramer, U., Schmahl, C., Swales, M., Taubner, S., Alvarez, M. M., & Sieg, J. & 30 experts with lived experience – clients, relatives, significant others - from 10 European countries (2024). Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers. Borderline personality disorder and emotion dysregulation , 11 (1), 14. https://doi.org/10.1186/s40479-024-00257-0 Rentrop, M., Gerra, M. L., & De Panfilis, C. (2025). Transference-focused psychotherapy (TFP) informed psychoeducation. In R. G. Hersh & C. De Panfilis (Eds.), Implementing transference-focused psychotherapy principles (pp. 49–82). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-68062-5_3 Rogers, B., & Dunne, E. (2011). They told me I had this PD … All of a sudden I was wasting their time: PD and the inpatient experience. Journal of Mental Health , 20 (3), 226–233. https://doi.org/10.3109/09638237.2011.556170 Rose, D. (2010). Service user perspectives on the impact of a mental illness diagnosis. Epidemiology and Psychiatric Sciences , 19 (3), 241–247. https://doi.org/10.1017/S1121189X00001186 Savin-Baden, M., & Howell Major, C. (2013). Qualitative Research: The Essential Guide to Theory and Practice (1st ed.). Routledge. https://doi.org/10.4324/9781003377986 Schleider, J. L. (2023). The fundamental need for lived experience perspectives in developing and evaluating psychotherapies. Journal of Consulting and Clinical Psychology , 91 (3), 119–128. https://doi.org/10.1037/ccp0000801 Sims, R., Michaleff, Z. A., Glasziou, P., & Thomas, R. (2021). Consequences of a diagnostic label: A systematic scoping review and thematic framework. Frontiers in Public Health , 9 , 725877. https://doi.org/10.3389/fpubh.2021.725877 Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews , 5 (5), CD012955. https://doi.org/10.1002/14651858.CD012955.pub2 Sulzer, S. H. (2015). Does difficult patient status contribute to de facto demedicalization? The case of borderline PD. Social Science & Medicine , 142 , 82–89. https://doi.org/10.1016/j.socscimed.2015.08.030 Tedesco, V., Day, N. J. S., Lucas, S., & Grenyer, B. F. S. (2024). Diagnosing borderline PD: Reports and recommendations from people with lived experience. Personality and Mental Health , 18 (2), 107–121. https://doi.org/10.1002/pmh.1599 Timulak, L., & Keogh, D. (2026). Observational Qualitative Psychotherapy Process Research. Journal of Contemporary Psychotherapy , 56 (1), 1–5. https://doi.org/10.1007/s10879-025-09690-w VERBI Software (2024). MAXQDA 2024 (Version 24) [Computer software]. https://www.maxqda.com Werkhoven, S., Anderson, J. H., & Robeyns, I. A. M. (2022). Who benefits from diagnostic labels for developmental disorders? Developmental medicine and child neurology , 64 (8), 944–949. https://doi.org/10.1111/dmcn.15177 Tables Table 1 Case-level characteristics of study participants Patient identification Gender Age Education Relatioship status Place of residence Lenght of TFP Diagnosis disclosure Diagnosis 201 Female 31 Master's degree Married Large city 4 years 3 months Yes PDs 202 Female 40 Master’s degree Informal relationship Large city 1 year 10 months Yes Paranoid and narcissistic PDs, anxiety disorders 203 Female 24 High school Informal relationship Large city 3 years 7 months Yes Borderline PD 204 Female 47 Ph.D. and academic degrees Married Small town 4 years 9 months Yes PDs 205 Male 27 Master’s degree Single Large city 1 year 10 months Yes Borderline PD 206 Female 27 Bachelor’s degree Single Large city 1 year Yes Borderline PD 302 Female 31 Master's degree Informal relationship Large city 2 years 7 months Yes Borderline and narcissistic PDs 208 Female 22 Bachelor's degree Informal relationship Rural area 5 years 4 months Yes Borderline PD 210 Female 31 Vocational school Single Large city 4 years 2 months Yes Mixed PD 303 Male 46 Master's degree Married Large city 9.5 Yes Narcissistic PD 304 Female 49 Master's degree Informal relationship Large city 3 years 8 months Yes Histrionic PD 207 Female 42 Master's degree Single Large city 2 years 10 months Yes Narcissistic PD 301 Male 31 Master's degree Informal relationship Rural area 3 years 3 months Yes Borderline PD 1 Female 30 Master’s degree Informal relationship Large city 1 year Yes Borderline, narcissistic, paranoid PDs 3 Female 25 Secondary education Informal relationship Large city 2 years Yes PDs 4 Male 36 Master’s degree Informal relationship Large city 7 months Yes Personality depression 305 Female 31 Master’s degree Single Large city 8 months Yes Borderline and narcissistic PDs Note. Place of residence was categorized as small town (5,000–50,000 inhabitants), medium-sized city (50,000–200,000 inhabitants), and large city (> 200,000 inhabitants). Additional Declarations Competing interest reported. The authors declare no financial competing interests. Some authors (MOJ, VB, EP) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9321171","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":623723467,"identity":"ef9a37b6-87ae-4525-9414-10319c6720b4","order_by":0,"name":"Monika Olga Jańczak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYJCCgw0MDMwQ5gEbCM0DxHxEaklDaGHDo4WxAc48cJiwFt323oMHZ9QwsPPPbn784ceZ8/K6MxIYH7xtY8jDpcXszLmEgxuOMTBL3DlmYNhz47bhthsJzIZz2xiKcWq5kWNw8AEb0C83chgSeD7cZgRqYZPmbWNIbMOr5R8DszxQy8E/H87ZA7Ww/yaoZWMbA7PBjRzGZp4bBxJBtjDj1XLmjMHBmX0SzIY30oyZZc4kJ28787BZcs45Cdx+Od5j/LHnm02y3I3kxx/fHLOz3XY8+eCHN2U2efw4tECBRDISBxxPEgn4dTAw2GGIENQyCkbBKBgFIwYAAOflYpCSc8LCAAAAAElFTkSuQmCC","orcid":"","institution":"Adam Mickiewicz University in Poznań","correspondingAuthor":true,"prefix":"","firstName":"Monika","middleName":"Olga","lastName":"Jańczak","suffix":""},{"id":623723468,"identity":"dc21e7b8-669e-496f-be0e-1d9be9b2338f","order_by":1,"name":"Marianna Izbaner","email":"","orcid":"","institution":"Adam Mickiewicz University in Poznań","correspondingAuthor":false,"prefix":"","firstName":"Marianna","middleName":"","lastName":"Izbaner","suffix":""},{"id":623723469,"identity":"d972ea0c-01b9-4c74-987b-aa164a865f98","order_by":2,"name":"Victor Blüml","email":"","orcid":"","institution":"Medical University of Vienna","correspondingAuthor":false,"prefix":"","firstName":"Victor","middleName":"","lastName":"Blüml","suffix":""},{"id":623723470,"identity":"9043afb5-1494-4fa3-998f-779edb1a01b1","order_by":3,"name":"Emanuele Preti","email":"","orcid":"","institution":"University of Milano-Bicocca","correspondingAuthor":false,"prefix":"","firstName":"Emanuele","middleName":"","lastName":"Preti","suffix":""},{"id":623723471,"identity":"0e8d7921-71e6-4107-b8e2-769a003a42c7","order_by":4,"name":"Emilia Soroko","email":"","orcid":"","institution":"Adam Mickiewicz University in Poznań","correspondingAuthor":false,"prefix":"","firstName":"Emilia","middleName":"","lastName":"Soroko","suffix":""}],"badges":[],"createdAt":"2026-04-04 14:25:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9321171/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9321171/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107245033,"identity":"d3c957a5-c7b9-4751-ba76-d80b7b3e258d","added_by":"auto","created_at":"2026-04-19 07:57:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":205998,"visible":true,"origin":"","legend":"\u003cp\u003eThematic structure of patients’ experiences of receiving diagnosis in TFP, illustrating the central role of the relational context and the possible temporal organisation of themes.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9321171/v1/09881b7549beb15a12ce774a.png"},{"id":107485956,"identity":"5b983648-5c57-4534-8db8-57a0f6f5d346","added_by":"auto","created_at":"2026-04-22 02:37:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":585891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9321171/v1/026d2593-31f0-4436-9f33-f5958b506b95.pdf"},{"id":107482199,"identity":"0cb6299d-eb28-41ac-89fe-3285a9f65199","added_by":"auto","created_at":"2026-04-22 02:22:33","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":17180,"visible":true,"origin":"","legend":"","description":"","filename":"FileS1.Codesandillustrativequotationsforallthemes.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-9321171/v1/d40d89f191c5c6d52818d92e.xlsx"},{"id":107483279,"identity":"47180fbe-85d1-4991-8154-12a73426b5b6","added_by":"auto","created_at":"2026-04-22 02:27:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18986,"visible":true,"origin":"","legend":"","description":"","filename":"TableS1.Detailedcharacteristicsofinterviewparticipants.docx","url":"https://assets-eu.researchsquare.com/files/rs-9321171/v1/f3951ccbeaadf0c8ab0e2467.docx"}],"financialInterests":"Competing interest reported. The authors declare no financial competing interests. Some authors (MOJ, VB, EP) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest.","formattedTitle":"Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy","fulltext":[{"header":"Practitioner Points","content":"\u003cul\u003e\n \u003cli\u003eReceiving a personality disorder diagnosis in psychotherapy may evoke mixed and changing emotional reactions (e.g., relief, fear, curiosity), highlighting the need for clinicians to approach diagnostic discussions with sensitivity and openness to dialogue.\u003c/li\u003e\n \u003cli\u003eDiagnostic communication may be most helpful when framed as a collaborative and ongoing process, in which the clinician links the diagnosis to the patient’s personal history, symptoms, and therapeutic work rather than presenting it as a fixed label.\u003c/li\u003e\n \u003cli\u003eClinicians should be attentive to patients’ independent searches for diagnostic information, particularly online, and support them in contextualising potentially simplified or stigmatizing descriptions within a clinically grounded understanding.\u003c/li\u003e\n \u003cli\u003eWhen discussing diagnoses associated with strong stigma (e.g., borderline or narcissistic PD), it may be helpful to emphasise the psychological suffering underlying these conditions, which can help protect the therapeutic alliance and promote reflection rather than shame or resistance.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eOver the past decades, the importance of integrating service users\u0026rsquo; perspectives into mental health research has gained increasing recognition (Schleider, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), as has the value of qualitative research in psychotherapy (McLeod et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Timulak \u0026amp; Keogh, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2026\u003c/span\u003e). Historically, individuals with lived or living experience\u0026mdash;and their significant others\u0026mdash;were treated primarily as passive subjects of research and clinical inquiry. More recently, however, a shift has occurred toward genuine collaboration between experts by profession and experts by experience (Ng et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Renneberg et al., 2024). Within this shift, people with lived and living experience\u0026mdash;including patients, relatives, and significant others\u0026mdash;have highlighted key priorities for improving mental health treatment. Among these are questions about whether disclosure of a personality disorder (PD) diagnosis may exacerbate or alleviate stigma, understood as the internalization of negative stereotypes and societal attitudes toward mental illness, which may reduce help-seeking and increase social withdrawal (Begum-Meades et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Masland \u0026amp; Sharp, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Renneberg et al., 2024).\u003c/p\u003e \u003cp\u003eSociological and critical perspectives emphasize that diagnosis functions as a powerful act of naming embedded in asymmetrical relations of knowledge and authority (Foucault, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1973\u003c/span\u003e). Rather than merely describing an underlying condition, diagnostic categories shape how individuals understand themselves and how they are perceived by others, often becoming integrated into personal identities and self-narratives (Jutel, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In this sense, disclosure of a diagnosis may represent a moment when externally defined clinical classifications intersect with lived experience, prompting processes of meaning-making and narrative reorganization. Recent critical accounts further suggest that diagnoses increasingly function not only as clinical tools but also as frameworks for identity and meaning, with the potential to both legitimize and constrain subjective experience (O\u0026rsquo;Sullivan, 2023). These processes may be particularly consequential in PDs, where diagnostic formulations directly concern enduring patterns of self-experience, interpersonal functioning, and relational expectations.\u003c/p\u003e \u003cp\u003eAgainst this background, diagnosis disclosure in mental health is increasingly recognized as more than a neutral act of conveying clinical information. Qualitative research consistently indicates that being informed of a diagnosis may constitute a pivotal and emotionally salient experience, with consequences that extend beyond symptom understanding to encompass identity, self-concept, and engagement with care (Perkins et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). From the perspective of service users, receiving a diagnostic label can simultaneously offer relief, validation, and a framework for making sense of distress, while also evoking uncertainty, fear, or concerns related to stigma, social positioning, and being reduced to a clinical category (Rose, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Lester et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). These findings suggest that the clinical significance of diagnosis disclosure lies not in the diagnostic label itself, but in how it is communicated, negotiated, and integrated into the therapeutic process.\u003c/p\u003e \u003cp\u003eIn PD treatment, communicating a diagnosis to the patient is a particularly sensitive clinical act. A diagnostic label can provide a shared framework for understanding, sharpen therapeutic focus, and guide treatment planning (Kendell \u0026amp; Jablensky, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Sims et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Importantly, its clinical value does not depend on correspondence to a discrete disease entity but on its ability to organize clinical understanding, inform decisions, and support collaborative treatment planning (Kendell \u0026amp; Jablensky, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). At the same time, diagnostic labels may reinforce stigma, evoke negative emotions, or become central to the patient\u0026rsquo;s identity (Finch \u0026amp; Mellen, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Sims et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Research shows that PD\u0026mdash;particularly borderline (BPD) and narcissistic PD\u0026mdash;is often perceived as a challenging diagnosis and may elicit unhelpful professional responses (Sulzer, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; James \u0026amp; Cowman, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Chartonas et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Service users frequently report inconsistent care, limited empathy toward self-harm, experiences of invalidation and powerlessness, and being perceived as manipulative (Ng et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Rogers \u0026amp; Dunne, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Conversely, research on collaborative and therapeutic assessment suggests that when diagnostic disclosure is approached as a joint reflective process, it can enhance patient autonomy, strengthen collaborative treatment planning, and increase access to meaningful diagnostic information (Finn, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Finn et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These contrasting perspectives highlight the clinical complexity of diagnosis disclosure in PD. More broadly, the impact of a diagnostic label depends not only on its content but also on who uses it, in what institutional context, and for what purpose (Werkhoven et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Nevertheless, empirical research remains limited, particularly regarding how patients experience and interpret this process within specialized, evidence-based psychotherapies.\u003c/p\u003e \u003cp\u003eTransference-Focused Psychotherapy (TFP) is one of four evidence-based, manualized treatments for personality disorders (PDs), alongside Mentalization-Based Therapy, Schema Therapy, and Dialectical Behavior Therapy (Storeb\u0026oslash; et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In these approaches, diagnosis typically serves as an entry point to collaborative case formulation, supporting early alliance building and patient engagement in the therapeutic process (Katerud \u0026amp; Kongerslev, 2019; Fasbinder et al., 2019). In TFP, disclosure and discussion of the diagnosis are integral to establishing the treatment contract, clarifying therapeutic focus, and developing a shared understanding of treatment goals (Rentrop et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Importantly, diagnostic disclosure in TFP is not a neutral transfer of clinical information but occurs within the therapeutic relationship, where meanings emerge through the analysis of transference and activated internal object relations (Caligor et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Caligor et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). From this perspective, patients\u0026rsquo; experience of receiving a diagnosis may depend not only on its content but also on two factors: the level of personality organization, which shapes defensive responses, and the quality of the transference relationship. However, no studies to date have examined how patients experience and interpret receiving and discussing their diagnosis, or how this process influences the therapeutic work. Addressing this gap is essential for understanding the role of diagnosis disclosure in PD treatment.\u003c/p\u003e"},{"header":"Aims of the study","content":"\u003cp\u003eThis study aims to explore how patients with PDs experience and make sense of diagnosis disclosure in the context of Transference-Focused Psychotherapy. Using a qualitative design, we examined patients’ retrospective accounts of being informed about their diagnosis, focusing on the emotional, relational, and therapeutic meanings they attribute to this process. By centering on the patients’ perspectives, our goal was to deepen the understanding of how diagnosis disclosure may shape the therapeutic experience, including engagement, self-understanding, and the development of the therapeutic relationship. This study addresses a gap in empirical literature by investigating diagnosis disclosure not as a technical procedure, but as a clinically meaningful event embedded in a psychodynamic treatment process.\u003c/p\u003e \u003cp\u003eThe overarching research question guiding the analysis was: How do patients in Transference-Focused Psychotherapy experience and make meaning of PD diagnosis disclosure?\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Materials \u0026 Methods","content":"\u003ch2\u003eStudy design and methodological framework\u003c/h2\u003e\u003cp\u003eThe current study forms part of a larger qualitative project on patient experiences in Transference-Focused Psychotherapy (TFP) (ZZ, YY, submitted). As part of this project, we conducted approximately one-hour interviews with TFP patients, followed by written open-ended questions. The present analysis focuses on responses to one written question concerning the meaning of being informed about one’s diagnosis. This component of the project was not preregistered. A qualitative approach was used as the most appropriate for capturing the subjective, meaning-laden, and complex ways in which patients encounter and make sense of diagnosis. We adopted a constructivist–interpretive stance, assuming that knowledge is co-constructed through the interaction between participants’ narratives and researchers’ interpretive lenses. Participants articulate their lived experiences through language, while researchers bring their own positioning and theoretical commitments to the analytic process (Crotty, \u003cspan class=\"CitationRef\"\u003e1998\u003c/span\u003e; Savin-Baden \u0026amp; Howell-Major, 2013; Levitt, \u003cspan class=\"CitationRef\"\u003e2020\u003c/span\u003e). The data were analyzed using reflexive thematic analysis (Braun \u0026amp; Clarke, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e; Braun et al., \u003cspan class=\"CitationRef\"\u003e2023\u003c/span\u003e), which allows for identifying and interpreting patterns of meaning in participants’ accounts while acknowledging the situated and reflective nature of knowledge creation.\u003c/p\u003e\n\u003ch3\u003eParticipants and Procedure\u003c/h3\u003e\n\u003cp\u003eWe used purposive sampling to enroll 17 patients with experience in Transference-Focused Psychotherapy (TFP): 11 in the advanced phase of treatment, 5 in the initial phase, and one who dropped out. Participants were recruited through their psychotherapists, all certified by the International Society of Transference-Focused Psychotherapy (ISTFP) and working in private outpatient practices in various cities across Poland. Therapists were identified through the national list of certified TFP practitioners (N\u0026thinsp;=\u0026thinsp;72), all of whom were contacted and invited to inform their patients about the study. Of these, 40 agreed to assist with recruitment, 3 declined, and the remaining therapists did not respond. Because recruitment relied on therapist-mediated invitations and voluntary self-selection, the number of eligible patients who were approached or declined participation is unknown.\u003c/p\u003e \u003cp\u003eTo be eligible, participants had to be at least 18 years old and no older than 65, fluent in Polish, engaged in TFP treatment. Because the study aimed to examine how patients experience receiving a PD diagnosis, we excluded three participants who, according to their recollection, had not received any diagnosis (n\u0026thinsp;=\u0026thinsp;2) or had received a non\u0026ndash;PD diagnosis (anxiety\u0026ndash;depressive disorder; n\u0026thinsp;=\u0026thinsp;1). At the time of the interview, participants had been in therapy for an average of 3,14 years (range: 0.6\u0026ndash;9.5 years). All patients had sessions twice weekly. The majority of the sample were female (76,5%) and had a Master\u0026rsquo;s degree (64,7%). In terms of relationship status, most of patients had a partner and were either married (17,6%) or in an informal relationship (52,9%). 23% of participants had children. The majority were employed full- or part-time (76%), lived in cities with over 200,000 residents (82,4%) and lived with a partner and/or children (41%). Seven participants (35%) reported a history of psychiatric hospitalization with an average number of hospitalization of 2 (range 1\u0026ndash;3). The majority of participants (88%) were currently taking psychiatric medication, and 76% declared no chronic somatic illness. More detailed individual characteristics of the study participants are presented in Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eInformation about participants\u0026rsquo; diagnoses was based on their self-reports, that is, on how they recalled and understood the diagnosis communicated by their therapist. No independent diagnostic assessment was conducted, and the study did not have access to formal clinical records. Accordingly, the study refers to participants\u0026rsquo; subjective understanding of their diagnosis rather than to independently verified PD diagnoses. Participants reported having received diagnoses of borderline PD (n\u0026thinsp;=\u0026thinsp;5), narcissistic PD (n\u0026thinsp;=\u0026thinsp;2), mixed PD (n\u0026thinsp;=\u0026thinsp;5), histrionic (n\u0026thinsp;=\u0026thinsp;1) and PD not otherwise specified (n\u0026thinsp;=\u0026thinsp;3), as well as single case of comorbid depression in personality disorders PD (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e \u003cp\u003eTherapists were asked to inform only those patients for whom participation would not be emotionally burdensome, based on their clinical judgment and, if needed, supervisory consultation. To minimize potential effects on the therapeutic process, therapists\u0026rsquo; role was limited to providing printed study information, including a link to the recruitment website. Interested patients contacted the research team independently. No independent assessments of adherence or competence were conducted; adherence to the TFP model was assumed based on therapist certification and confirmation that the patients had been treated using TFP.\u003c/p\u003e \u003cp\u003e Each participant provided written informed consent prior to the study. As a token of appreciation for their time and contribution, each participant received a 200 PLN shopping voucher. The study protocol was reviewed and approved by the Ethics Committee of [anonymized for peer review], decision no. 04/02/2025.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected between March and June 2025. As part of a questionnaire administered after questions concerning TFP psychotherapy duration and frequency, participants were asked whether they had been informed about their diagnosis at any stage of the therapeutic process (yes/no). If so, they were asked to specify the diagnosis in an open-ended format. Participants were then invited to respond in writing to the following open-ended question: \u0026ldquo;\u003cem\u003eWhat did it mean to you that you were (or were not) informed about your diagnosis? Please elaborate on your answer so that we can understand your experience as fully as possible\u003c/em\u003e.\u0026rdquo; Responses were provided in written form via the questionnaire. In total, 17 written statements were collected, with responses averaging 69.9 words (SD\u0026thinsp;=\u0026thinsp;49.1; range: 3\u0026ndash;192 words).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe qualitative data analysis followed the general procedures of reflexive thematic analysis as described by Braun and Clarke (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2006\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, Braun et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). We adhered to the general six-phase process: (1) familiarization with the data, (2) coding, (3) generating initial themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report. Initially, ES and MI familiarized themselves with the written accounts provided by patients and independently coded five randomly selected cases to calibrate the level of coding detail. After discussing their approaches, both independently coded the entire dataset and then met to examine areas of convergence and divergence. MI tended to code more explicitly (focusing primarily on the semantic level of the data, i.e., what participants directly articulated), whereas ES worked more implicitly (engaging more strongly with latent meanings and interpretative patterns underlying the data; Braun et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). These complementary perspectives enriched the process, and both sets of codes formed the foundation for theme development. In the next phase, each researcher generated preliminary themes separately, after which joint discussions were held to establish a shared thematic structure. One theme (related to diagnosis as a stimulus for personal development and as connected to identity) was found to lack sufficient precision. Thus, we revisited the relevant codes and reformulated the theme. The final set of themes and corresponding codes was discussed with MOJ, whose feedback contributed to refining the thematic structure. Through this discussion, the research team further developed and clarified the thematic interpretation, and the themes reported in this article represent the final analytic account produced by the team. All coding was conducted manually using Microsoft Excel spreadsheets, which enabled systematic organization and comparison of codes and themes across researchers. The data were collected and analyzed in Polish, and the final report was prepared in English, with careful attention to preserving participants\u0026rsquo; original meanings while ensuring accessibility for an international readership.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTrustworthiness\u003c/h2\u003e \u003cp\u003eTo ensure trustworthiness, we implemented strategies aligned with reflexive thematic analysis and reported them transparently. First, we engaged in prolonged immersion in the dataset through iterative reading and re-reading of the full corpus. Second, we used analyst triangulation understood as dialogic and reflexive collaboration: YY and XX calibrated the granularity of coding on an initial random subset, independently coded the full dataset, and then met to examine convergences and productive divergences. The complementarity of more explicit (XX) and more implicit (YY) coding enhanced sensitivity to both manifest and latent meanings in participants\u0026rsquo; accounts. Team discussions iteratively linked developing interpretations back to the raw data and, where appropriate, situated them within relevant clinical contexts. Third, we maintained an audit trail comprising dated coding spreadsheets (Excel), code lists, thematic maps, and decision logs. For each theme, we preserved a transparent chain of evidence (theme \u0026rarr; codes \u0026rarr; illustrative extracts), provided in the Supplementary File S1. Given that all team members were trained within a psychodynamic tradition, we treated this shared positioning as both a resource and a potential constraint. We documented our stance through brief reflexive memos, considered alternative readings, and guarded against confirmation bias. Consistent with the epistemology of reflexive thematic analysis, we did not compute inter-coder reliability indices; instead, we prioritized interpretative coherence, transparency of the analytic decision trail, and resonance between themes and data excerpts.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearch team and reflexivity\u003c/h3\u003e\n\u003cp\u003eWe considered the positionality of the research team as an integral element of the analytic process. The team responsible for data analysis and preparation of the report consisted of three members, all affiliated with the same institution but representing different professional trajectories within psychology\u0026mdash;each grounded in a psychodynamic orientation. ZZ is a psychodynamic psychotherapist and supervisor, trained in Transference-Focused Psychotherapy, and a researcher in clinical psychology and psychotherapy. MI is a PhD student in clinical psychology who is training as a psychodynamic therapist (MBT) but has not been trained in TFP. ZZ and XX drew more heavily on their clinical experience in interpreting participants\u0026rsquo; accounts. YY is trained in psychodynamic psychotherapy (not TFP) but currently identifies primarily as a researcher in clinical psychology, specializing in qualitative methodologies. This brought a focus on analytic rigor and sensitivity to language while minimizing potential therapeutic allegiance bias. Importantly, only XX and YY had a direct access to the data and conducted the thematic analysis, with ZZ providing supervisory input on the emerging themes and interpretations. At the same time, the fact that all team members shared a psychodynamic background may have sensitized us to particular aspects of the data while limiting engagement with alternative perspectives.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn response to the research question\u0026mdash;how patients undergoing Transference-Focused Psychotherapy experience the communication of a PD diagnosis, what the disclosure or possibility of diagnostic disclosure means to them, and what meanings they attribute to diagnosis within psychotherapy\u0026mdash;we identified six themes that structured patients\u0026rsquo; experiences of diagnostic communication (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e[Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: The Diagnosis as Verdict\u003c/h2\u003e \u003cp\u003eThe initial diagnostic encounter could function as a rupture in self-narratives, triggering cognitive dissonance between internalised self-concepts and clinical categorisation. Rather than offering clarification, the diagnosis was experienced as an ontological threat\u0026mdash;a pronouncement that crystallised participants' sense of fundamental difference from others while activating culturally embedded stigma schemas. We interpret these accounts as indicating that diagnosis functioned not merely as clinical information, but as a symbolic verdict that reconfigured participants' self-understanding in relation to socially available meanings of PD.\u003c/p\u003e \u003cp\u003eConfronting prior beliefs about oneself with the diagnosis led to significant cognitive dissonance for some participants. A 42-year-old woman stated: \"When I heard the diagnosis: narcissistic PD, I was shocked (...) It took me a long time getting used to the diagnosis\" (207). Prevailing knowledge about the diagnosis, shaped by cultural narratives and clinical experience, determined how it was perceived. Participants also referred to the timing of receiving the diagnosis within therapy, which formed part of how they retrospectively made sense of the diagnostic disclosure. A 24-year-old woman with borderline PD explained: \u0026ldquo;I received the diagnosis only after about two years of therapy. It was hard for me to hear because I know people with BPD and the suffering it involves, and I also know that prognosis for recovery isn't encouraging\" (203). Regardless of the clinical timing of disclosure, participants\u0026rsquo; recollections of when and how the diagnosis was communicated shaped their subjective experience of the diagnostic process.\u003c/p\u003e \u003cp\u003eThe diagnosis confronted pre-existing self-beliefs and generated existential anxiety, sometimes experienced as an exposure of inherent difference marked by stigma. A 25-year-old patient with narcissistic PD felt: \"I was an outsider\u0026mdash;someone different from the rest of society, which could have deepened my tendency towards isolation and temporarily lowered my self-esteem\" (03). One participant admitted: \"I couldn't accept it and treated it as a verdict\" (207). Thus, hearing the diagnosis sometimes solidified entrenched negative beliefs about oneself, as in the case of mentioned patients with narcissistic PD.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Diagnosis as Frame of Reference\u003c/h2\u003e \u003cp\u003eBeyond its descriptive function, the diagnosis operated as a pragmatic tool that transformed passive suffering into actionable problems. Participants described how diagnostic framing enabled treatment navigation, structured therapeutic goals, and facilitated a shift from bewilderment to agency\u0026mdash;positioning the diagnosis not merely as knowledge about the self, but as knowledge for action upon the self.\u003c/p\u003e \u003cp\u003eHearing the diagnosis allowed naming what caused suffering and situating it within a broader system of meanings, bringing relief and a sense of control. One participant described: \"It reinforced my belief that my difficulties are not due to recurring depression alone but partly the result of how I perceive the world and others\" (MJ001/201). A 25-year-old participant explained: \"It gave me the opportunity to gather information about these disorders\u0026mdash;I read extensively, and when I recognised my difficulties in this material, it became easier to find ways to deal with them and function more normally.\"\u003c/p\u003e \u003cp\u003eReceiving a diagnosis enabled patients to position themselves socially and legitimize their suffering in the eyes of others. A 47-year-old woman highlighted: \"It allowed me to place myself within a system of behaviours and experiences (...) It became easier to define myself in relation to others\" (204). A participant with borderline PD stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI really wanted to know if there is something wrong with me, or if I'm just exaggerating and looking for a problem, to name it somehow. It gave me relief and a bit more understanding of myself; I also had something to tell my parents so that they would acknowledge my problems as real (208).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants reported that a key aspect of hearing the diagnosis was the possibility of better self-understanding. While this process was painful for some due to revealing a difficult truth, it also opened the path to more constructive thinking about oneself. A 25-year-old participant noted: \"I could anchor myself in who I am beyond what I already know about myself. My self-awareness grew; I could observe myself and my behaviour more clearly\" (03).\u003c/p\u003e \u003cp\u003eThe diagnosis served as a means to build a coherent sense of self within the arc of one's life history. A 49-year-old woman with histrionic PD stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think of it as a tool that can help me see certain patterns\u0026mdash;like a strong need to be noticed, emotional expressiveness, dependence on others' approval\u0026mdash;and start examining where this comes from and how to deal with it in a healthy way. PDs are difficult, but they're not fixed and unchangeable. Every PD is a story about something difficult that happened in childhood (304).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: The Relational Context of Diagnostic Disclosure\u003c/h2\u003e \u003cp\u003ePatients experienced the diagnosis as a relationally situated event, emphasising the importance of the therapeutic relationship and the therapist as a supportive figure in adapting to the new information. The context of diagnostic delivery\u0026mdash;particularly the quality of the therapeutic alliance\u0026mdash;shaped whether the diagnosis was experienced as helpful or threatening.\u003c/p\u003e \u003cp\u003eA 30-year-old woman with mixed PDs stated: \"It gave me a sense of assurance and safety; if something is named, it can be identified and worked with, mitigated\" (01). A 25-year-old patient admitted: \"I felt relief, as it was another voice saying that I am suffering from a PD (from the specialist)\" (03).\u003c/p\u003e \u003cp\u003ePatients stressed the significance of the therapeutic relationship as a condition enabling acceptance of the diagnosis. One participant explained: \"This mattered a lot to me because I regarded my therapist as an authority, someone who tells me the truth and knows about this\" (01). A 22-year-old woman with borderline PD said: \"Fortunately I came to my therapist, who supported me and explained many things, assuring me that her role is to help\" (208). One participant shared: \"My therapist reassured me that in my case the disorder is not highly advanced, and I have good chances for normal functioning; the therapy I am in gives me these chances\" (203). A 46-year-old man with narcissistic PD highlighted: \"Simply naming the disorder wasn't decisive; what mattered in the early years of therapy was understanding that my therapist understands what I am dealing with\" (303).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Digital (Dis)information and Diagnostic Stigma\u003c/h2\u003e \u003cp\u003eParticipants' engagement with online diagnostic content revealed a critical gap between clinical and popular understandings of PDs. The internet emerged as an unregulated interpretive space where diagnostic labels became detached from therapeutic context, exposing patients to catastrophising narratives and stigmatising discourse that undermined the containing function of the therapeutic relationship.\u003c/p\u003e \u003cp\u003eA 40-year-old woman with narcissistic PD stated: \"I read about it on the internet; the internet, as always, showed me dreadful scenarios; the reality turned out to be easier\" (MJ002/202). Another patient shared: \"There is a risk of becoming obsessed with this topic and blaming myself for all the negative things so prevalent on the internet\" (01).\u003c/p\u003e \u003cp\u003eThe effect of self-directed information seeking heightened anxiety and significantly worsened self-esteem for some patients. One patient with borderline PD underscored:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"At the same time, such a diagnosis was difficult for me because it involves stigma; I started reading a lot of simplifications and untruths about PDs on the internet, and I was frightened; I felt that I might know what is wrong with me, but I cannot get help, I began to think I am a monster. After reading various forums about how people with such a diagnosis destroy others, that one should run away from them, etc., my suicidal thoughts intensified\" (208).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile the therapeutic context can provide frameworks for communicating the diagnosis in a psychologically safe way, the internet\u0026mdash;especially social media\u0026mdash;constitutes a space where patients become exposed and vulnerable to destabilising information.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Diagnosis as Tool for Change\u003c/h2\u003e \u003cp\u003eBuilding on the diagnostic frame described in Theme 2, participants articulated how diagnosis moved beyond meaning-making to actively shape decisions, actions, and engagement in the therapeutic process. The diagnosis functioned as a practical guide in the recovery process, helping patients choose appropriate forms of therapy and enabling a shift from helplessness to agency and hope for change.\u003c/p\u003e \u003cp\u003eThe diagnosis often functioned as an indicator of what kind of help to seek. A 27-year-old patient with borderline PD noted: \"I already knew my diagnosis (MMPI\u0026thinsp;+\u0026thinsp;SCID) and, based on it, I was looking for therapy\" (205). A 47-year-old woman emphasised: \"It also justified the need to start psychotherapy\" (204). A 36-year-old patient admitted that the diagnosis developed during therapy redirected his treatment: \"It prompted me, encouraged by the psychotherapist, to move away from pharmacological treatment\" (04). One patient with borderline PD noted that the diagnosis marked the first step towards acknowledging the need for help: \"Somehow it helped me allow myself to feel that it is hard for me and to agree to help\" (208).\u003c/p\u003e \u003cp\u003eThe diagnosis was experienced as helpful in engaging with therapy through the structure it afforded. A 40-year-old woman with narcissistic PD explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt also helped me understand what to think about in terms of psychotherapy, what to talk about; even what I read online helped me know what to say in therapy, which threads to bring in, because at the start I didn't know what to talk about (MJ002/202).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA 46-year-old man with narcissistic PD shared: \"Moreover, I think it was important at different stages to revisit the diagnosis and understand through its lens what I am doing or what is happening to me\" (303).\u003c/p\u003e \u003cp\u003eFrom patients' perspectives, the diagnosis brought agency over illness. A 31-year-old woman noted: \"It allowed me to look at myself differently, to see that much depends on me, not just that I am ill\" (MJ001/201). A patient with borderline PD highlighted: \"It comforts me to know what is wrong with me because I can understand myself better and work on changing behaviours I don't like and that hinder my functioning\" (206).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 6: Living with the Diagnosis Over Time\u003c/h2\u003e \u003cp\u003eThe subjective experience of diagnosis was fundamentally temporal, with initial distress gradually yielding to more nuanced and integrated understandings. This temporality reflects participants' retrospective narrative reconstructions of change unfolding within psychotherapy. Participants reworked the diagnosis from an external imposition into a flexible cognitive tool\u0026mdash;one that could be held, examined, and selectively incorporated into identity without becoming identity-defining.\u003c/p\u003e \u003cp\u003eInitially difficult to accept, the diagnosis became workable as it was given meaning within the context of personal experiences through psychotherapy. A 46-year-old man with narcissistic PD stated: \"In the end, I think what mattered in this process was not only understanding the diagnosis but also accepting it\" (303). A 49-year-old woman with histrionic PD emphasized: \"The diagnosis does not define who I am\" (304).\u003c/p\u003e \u003cp\u003eSome patients noted that the formal diagnostic process may be imperfect or erroneous. A 27-year-old patient recalled:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSince I was 14, I have been given various diagnoses\u0026mdash;anorexia, bulimia, depression, obsessive-compulsive disorder. No medications helped, and I felt bad. Only when I started therapy around 21 did I hear the borderline diagnosis, and I agree with that now (206).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor most patients, the relationship to the diagnosis shifted from negative to positive. One participant reflected: \"Ultimately, having received a diagnosis was painful but helpful and necessary, and long term it gave more than it momentarily hindered me. It gave significance and truth to my suffering\" (208). However, not all patients shared this view. One patient with mixed PD stated: \u0026ldquo;After some time, however, the diagnosis became a stigma for me because I probably read too much about it on the internet\u0026rdquo; (210). At the same time, ambivalence remained. A 42-year-old woman with narcissistic PD acknowledged:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo this day I think of myself as a person with a disorder... at the same time I think that without hearing the diagnosis it would have been hard for me to feel the gravity of my problem, and I might still downplay my state and thus not strive to change my unsatisfactory situation (207).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOverall, the experience of hearing the diagnosis appeared to have potential for greater integration despite the difficult emotions it provoked.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored how patients in Transference-Focused Psychotherapy experience and make sense of receiving a PD diagnosis, with particular attention to how it shapes engagement in therapy, self-understanding, and the therapeutic relationship. In general, being informed about the diagnosis was described as a complex and emotionally charged experience, evoking a wide range of reactions, including surprise, fear, relief, gratitude, curiosity, and at times even joy. Most participants reported an ambivalent relationship to the diagnosis, with its meaning evolving over time through therapeutic work, new information, and personal reflection. It must be noted though, that within the TFP framework, disclosure of a PD diagnosis can be understood as a relational intervention that activates dominant object-relational dyads (Caligor et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Felici et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). In this context, the quality of the transference relationship may shape how the diagnosis is experienced and integrated by the patient. The findings should also be considered in light of the study sample: participation was voluntary and therapists invited patients for whom participation was unlikely to be emotionally burdensome. As a result, the sample may primarily reflect the perspectives of relatively better-functioning patients engaged in TFP. Overall, six themes were identified that captured different aspects of how patients understood and integrated the diagnosis into their therapeutic experience.\u003c/p\u003e \u003cp\u003eOur findings indicate that the experience of diagnosis was fundamentally relational (Theme 3: \u003cem\u003eThe Relational Context of Diagnostic Disclosure\u003c/em\u003e). Importantly, in patient\u0026rsquo;s experience, the way in which the diagnosis was communicated appeared to shape how it was subsequently understood and integrated. When conveyed within the therapeutic relationship, the diagnosis was more often described as tolerable, meaningful, and integrated into an ongoing process of change, in contrast to diagnoses encountered in isolation, such as through self-directed online searches. Nevertheless, for many participants, the initial diagnostic encounter disrupted their self-narratives and created cognitive dissonance between long-held self-concepts and the clinical categorization (Theme 1: \u003cem\u003eThe Diagnosis as Verdict\u003c/em\u003e\u003cb\u003e)\u003c/b\u003e. Rather than providing clarity, the diagnosis was experienced as an external verdict that intensified feelings of difference, activated stigma-related meanings, and temporarily undermined self-esteem. Importantly, this pattern was observed among participants who reported receiving different diagnoses (e.g., borderline and narcissistic personality disorder), as these themes appeared across many narratives. These accounts suggest that diagnostic disclosure may function not only as clinical information but also as a symbolic event with the potential to reshape identity, sometimes in constraining ways. Two potential clinical factors may contribute to the extent to which patients experience the diagnosis as threatening or destabilizing. First, patients functioning at different levels of personality organization, characterized by different predominant defense mechanisms, may respond to diagnostic disclosure in markedly different ways. More primitive defenses based on splitting and projection may increase the likelihood that the diagnosis will be experienced as a threat, criticism, or external attack on the self (Clarkin et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Second, the configuration of the transference relationship may substantially influence how the diagnosis is experienced and interpreted. For example, patients with more paranoid or narcissistic features may be more likely to experience the diagnosis as a source of shame or threat, whereas patients with more neurotic personality may respond in potentially less persecutory way. Future studies should address this heterogeneity and examine whether the experience of diagnosis disclosure differs across specific PD diagnoses.\u003c/p\u003e \u003cp\u003eAs therapy progressed, participants came to experience the diagnosis as more than a descriptive label; it functioned as a practical framework that helped translate diffuse distress into identifiable and workable therapeutic targets (Theme 2: \u003cem\u003eDiagnosis as Frame of Reference).\u003c/em\u003e At the same time, the diagnosis served as a reference point for therapeutic work, helping to organize and guide efforts toward change (Theme 5: \u003cem\u003eDiagnosis as Tool for Change\u003c/em\u003e). For many, naming their difficulties ultimately brought relief, greater self-understanding, and a sense of agency, supporting a shift from confusion to more goal-directed engagement in treatment. However, even over time, some participants struggled to move beyond the diagnosis \u0026mdash; becoming overly absorbed in diagnostic information or increasingly defining themselves through the lens of having a disorder. Rather than serving as a framework for understanding, the diagnosis became a fixed lens through which the self was perceived. This could also be understood as perpetuating a pattern of seeing oneself primarily as the victim of \u0026ldquo;bad\u0026rdquo; parental objects and past relational experiences. This suggests that experiencing diagnosis may sustain a more passive or victim-oriented representation of the self. From a TFP perspective, such reactions may reflect the activation of internal object relations and defensive patterns that organize the patient\u0026rsquo;s experience of the diagnosis within the transference (Caligor et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Caligor et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, our findings align with well-established recommendations that patients with PDs should be actively involved in collaborative discussions about diagnosis and treatment, including psychoeducation tailored to the disorder (Keepers et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Within Transference-Focused Psychotherapy, the explicit sharing and ongoing discussion of the diagnosis is strongly emphasized as a foundation for treatment planning, contracting, and the therapeutic focus. At the same time, our results resonate with broader concerns raised by individuals with lived experience, who have highlighted that the impact of diagnostic disclosure depends critically on the conditions under which it occurs and the meanings that patients subsequently attribute to the label (Renneberg et al., 2024). These concerns include how diagnostic labels may shape or transform a person\u0026rsquo;s identity over the course of treatment, the potential for stigma associated with PD diagnoses, and the influence of both the manner of disclosure and the quality of subsequent treatment. Importantly, in psychodynamic treatment these processes unfold not only at an explicit, reflective level but also within the transference relationship, where the diagnosis may become embedded in ongoing relational patterns and unconscious meanings that shape how it is experienced and integrated over time.\u003c/p\u003e \u003cp\u003eAlthough a diagnosis of PD may initially be experienced as stigmatizing, participants\u0026rsquo; accounts suggest that this experience can evolve over time and that stigma is not a fixed or inevitable outcome (Theme 4. \u003cem\u003eDigital (Dis)information and Diagnostic Stigma\u003c/em\u003e\u003cb\u003e)\u003c/b\u003e. Our findings indicate that stigma may be mitigated when diagnostic information is communicated within a reflective therapeutic relationship and accompanied by collaborative discussion and psychoeducation. Studies drawing on lived experience perspectives showed that when clearly communicated, contextualised, and linked to meaningful treatment options, receiving a PD diagnosis has been described as a turning point that supports insight, enhances patient autonomy, facilitates access to appropriate interventions, and fosters hope for recovery (Lester et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tedesco et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In contrast, participants\u0026rsquo; narratives point to the potentially iatrogenic effects of seeking diagnostic information independently, particularly through online sources, where oversimplified, decontextualized, or pathologizing portrayals of PDs may intensify fear, self-stigmatization, or diagnostic foreclosure (Monteith et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Our findings also suggest that patients do not remain passive recipients of a PD diagnosis; rather, they actively engage with it, interpret it, and attempt to integrate it into their understanding of themselves and their lives (Theme 6: \u003cem\u003eLiving with the Diagnosis Over Time).\u003c/em\u003e The present study therefore shifts the focus from whether a diagnosis should be disclosed to how patients work with diagnostic information\u0026mdash;how they negotiate its meanings, resist or reinterpret stigmatizing aspects, and use the diagnosis as a resource for self-understanding and change within and beyond the therapeutic context.\u003c/p\u003e \u003cp\u003eWhile these themes emerged independently and no single participant presented a complete narrative encompassing all stages, they may be seen as a temporal process of experiencing diagnosis: initially as a verdict\u0026mdash;difficult to accept and disrupting one's sense of self and others, particularly when explored independently online; subsequently as a framework enabling self-definition and motivating therapeutic engagement; and ultimately as an integrated experience transformed through reflection and meaning-making. The therapeutic relationship appears as a central element present throughout all stages, functioning as a holding environment that allows various emotions to be experienced safely. Consistent with work on collaborative diagnosis (Hackmann et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), our findings suggest that even when diagnostic disclosure concerns the communication of a diagnostic label rather than the diagnostic process itself, patients attribute particular importance to the relational context as shaping whether the consequences of diagnosis are experienced as supportive or harmful.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eThe present findings underscore that patients\u0026rsquo; experiences of diagnosis are highly individual, dynamic, and subject to change over time. Rather than offering prescriptive rules about what clinicians should or should not do, the results highlight key areas of sensitivity and clinical attunement. First, diagnostic communication may be most helpful when approached as a collaborative process rather than a one-sided act of disclosure. In TFP, although the clinician holds responsibility for establishing the diagnosis, it is important to discuss it with the patient and link the diagnostic formulation to the patient\u0026rsquo;s personal history and the function of their symptoms, which may reduce shame and support a more reflective understanding of their difficulties. Rather than avoiding diagnostic disclosure for fear of causing offense, clinicians should recognize that such information may evoke strong emotions and should be addressed through ongoing dialogue about its meaning for the patient. Second, working with a diagnosis should be understood as an ongoing process rather than a single event; clinicians may benefit from revisiting the diagnosis over time and exploring how its meaning and relevance evolve in the course of treatment.\u003c/p\u003e \u003cp\u003eParticular clinical attention should be paid to patients\u0026rsquo; independent searches for diagnostic information, especially online. When communicating a diagnosis, it may be helpful to explicitly acknowledge that internet-based descriptions can be simplified, distorted, or stigmatizing, and to support patients in maintaining a clinically grounded understanding of what the diagnosis means in the context of their own experience and therapeutic work. Therapists should be aware of the cultural context associated with the diagnosis and actively explore what meaning the diagnosis holds for the patient, as patients may have pre-existing beliefs shaped not only by information obtained online, but also by discourse created within their own socio-cultural environment. In the many cultural contexts, diagnoses of narcissistic and borderline PDs carry particularly heavy stigma. When communicating such diagnoses, clinicians should emphasize the psychological suffering inherent in these conditions, framing them as sources of distress rather than character flaws. This approach helps ensure that the diagnosis serves to strengthen the therapeutic alliance rather than undermine it, fostering collaboration and hope instead of shame and resistance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has a few limitations that need to be acknowledged. A key limitation of the study concerns the sampling procedure. Participation was voluntary and based on self-selection, with patients deciding independently whether to take part. In addition, for ethical reasons therapists were asked to inform only those patients for whom participation would not be emotionally burdensome or potentially disruptive to the therapeutic process. Moreover, in Poland TFP is currently practiced primarily by therapists working in private practice, which means that patients receiving this treatment are typically individuals who are functioning well enough to afford psychotherapy. As a result, the sample likely overrepresents individuals who were willing and able to reflect on their experiences in therapy, while patients experiencing more negative or paranoid transeference, greater distress, disengagement, or more general negative views of TFP may be underrepresented. Accordingly, the findings should be understood as capturing the perspectives of patients who chose to articulate their experiences, rather than representing the full range of possible responses to TFP.\u003c/p\u003e \u003cp\u003eAnother limitation is that the study relies exclusively on patients\u0026rsquo; retrospective accounts of how the nosological diagnosis was discussed during TFP. We do not have access to independent or objective information about the diagnostic communication itself; thus, the findings reflect patients\u0026rsquo; subjective experiences and interpretations rather than verified descriptions of how the diagnosis was conveyed in therapy. Third, all members of the research team were trained within a psychodynamic framework. While this shared orientation facilitated interpretive coherence and provided a meaningful basis for studying the communication of diagnosis in TFP, it may also have narrowed the analytic lens and limited engagement with alternative perspectives. The dual roles of the researchers as clinicians and analysts further shaped the interpretation of patient accounts, enriching the analysis with clinical sensitivity but also carrying the risk of projecting therapeutic assumptions onto the data. To mitigate this, we maintained a continuous reflective stance throughout the analytic process.\u003c/p\u003e \u003cp\u003eFourth, the analysis was conducted in Polish, with findings reported in English. Although care was taken to preserve semantic integrity in translation, subtle shifts in meaning cannot be ruled out. The use of Microsoft Excel as the main tool for coding ensured transparency but offered fewer functionalities than specialized qualitative software; however, this solution was adequate given the modest size of the dataset.\u003c/p\u003e \u003cp\u003eFinally, the findings are situated within the Polish psychotherapeutic context, where practices of communicating nosological diagnoses have changed considerably in the past decade. This specificity may limit the transferability of the results to contexts in which diagnostic practices differ. At the same time, it does not alter the central point we wish to emphasize\u0026mdash;that whether or not a diagnosis is communicated constitutes a significant element of the therapeutic relationship and extends beyond the therapeutic context, becoming part of the patient\u0026rsquo;s lived reality and its ongoing transformations.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosure Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no financial competing interests. Some authors (A1, A3, A4, blinded for review) \u0026nbsp;are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no financial competing interests. Some authors (MOJ, VB, EP) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest.\u003c/p\u003e\n\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis research was funded by the [blinded for review], project no. 140/04/POB5/0005, awarded to Author 1.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eThe authors declare no financial competing interests. Some authors (A1, A3, A4, blinded for review) are trained in Transference-Focused Psychotherapy (TFP), which may constitute a non-financial professional interest.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eDue to the sensitive and potentially identifiable nature of the interview material, the full qualitative dataset (i.e., interview transcripts) cannot be made publicly available. Sharing the complete transcripts could compromise participant confidentiality. To enhance transparency of the analytic process, the Appendix provides the coding framework underlying each theme, including the associated codes and illustrative participant quotations drawn from the data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBegum-Meades, R., Feilder, S., \u0026amp; Crawford, M. J. (2025). Prevalence and Correlates of Self-Stigma in Personality Disorder Compared With Anxiety and Depression: A National Cross-Sectional Survey. \u003cem\u003ePersonality and mental health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(2), e70011. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pmh.70011\u003c/span\u003e\u003cspan address=\"10.1002/pmh.70011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun, V., \u0026amp; Clarke, V. (2006). Using thematic analysis in psychology. \u003cem\u003eQualitative Research in Psychology\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(2), 77\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1191/1478088706qp063oa\u003c/span\u003e\u003cspan address=\"10.1191/1478088706qp063oa\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun, V., \u0026amp; Clarke, V. (2021). Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern-based qualitative analytic approaches. \u003cem\u003eCounselling and Psychotherapy Research\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 37\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/capr.12360\u003c/span\u003e\u003cspan address=\"10.1002/capr.12360\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun, V., Clarke, V., Hayfield, N., Davey, L., \u0026amp; Jenkinson, E. (2023). Doing reflexive thematic analysis. In S. Bager-Charleson, \u0026amp; A. McBeath (Eds.), \u003cem\u003eSupporting research in counselling and psychotherapy: Qualitative, quantitative, and mixed methods research\u003c/em\u003e (pp. 19\u0026ndash;38). Springer International Publishing.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaligor, E., Diamond, D., Yeomans, F. E., \u0026amp; Kernberg, O. F. (2009). The interpretive process in the psychoanalytic psychotherapy of borderline personality pathology. \u003cem\u003eJournal of the American Psychoanalytic Association\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(2), 271\u0026ndash;301. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0003065109336183\u003c/span\u003e\u003cspan address=\"10.1177/0003065109336183\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaligor, E., Kernberg, O. F., Clarkin, J. F., \u0026amp; Yeomans, F. E. (2018). \u003cem\u003ePsychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning\u003c/em\u003e (1st ed.). American Psychiatric Publishing Inc.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChartonas, D., Kyratsous, M., Dracass, S., Lee, T., \u0026amp; Bhui, K. (2017). PD: Still the patients psychiatrists dislike? \u003cem\u003eBJPsych Bulletin\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(1), 12\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/pb.bp.115.053249\u003c/span\u003e\u003cspan address=\"10.1192/pb.bp.115.053249\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke, V., \u0026amp; Braun, V. (2017). Thematic analysis. \u003cem\u003eThe Journal of Positive Psychology\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(3), 297\u0026ndash;298. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17439760.2016.1262613\u003c/span\u003e\u003cspan address=\"10.1080/17439760.2016.1262613\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarkin, J. F., Lenzenweger, M. F., Yeomans, F., Levy, K. N., \u0026amp; Kernberg, O. F. (2007). An object relations model of borderline pathology. \u003cem\u003eJournal of personality disorders\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(5), 474\u0026ndash;499. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1521/pedi.2007.21.5.474\u003c/span\u003e\u003cspan address=\"10.1521/pedi.2007.21.5.474\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrotty, M. (1998). \u003cem\u003eThe Foundations of Social Research: Meaning and Perspective in the Research Process\u003c/em\u003e. SAGE Publications Inc.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFassbinder, E., Wilde, O. B. D., \u0026amp; Arntz, A. (2019). Case Formulation in Schema Therapy: Working with the Mode Model. In U. Kramer (Ed.), Case Formulation for Personality Disorders: Tailoring Psychotherapy to the Individual Client (pp. 77\u0026ndash;94). Elsevier Academic Press. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/B978-0-12-813521-1.00005-9\u003c/span\u003e\u003cspan address=\"10.1016/B978-0-12-813521-1.00005-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFelici, C., Preti, E., Madeddu, F., \u0026amp; Kramer, U. (2025). In the process of transference-focused psychotherapy: Application of an observer rating grid for object relations dyads on a psychotherapy session. \u003cem\u003eJournal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy.\u003c/em\u003e Advance online publication. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10879-025-09710-9\u003c/span\u003e\u003cspan address=\"10.1007/s10879-025-09710-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinch, E. F., \u0026amp; Mellen, E. J. (2025). Labeled, Criticized, Looked Down On: Characterizing the Stigma of Narcissistic Personality Disorder. \u003cem\u003ePersonality and mental health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(2), e70015. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pmh.70015\u003c/span\u003e\u003cspan address=\"10.1002/pmh.70015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinn, S. E. (2007). \u003cem\u003eIn our clients\u0026rsquo; shoes: Theory and techniques of therapeutic assessment\u003c/em\u003e. Lawrence Erlbaum Associates.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFinn, S. E., Fischer, C. T., \u0026amp; Handler, L. (2012). Collaborative/therapeutic assessment: Basic concepts, history, and research. In S. E. Finn, C. T. Fischer, \u0026amp; L. Handler (Eds.), \u003cem\u003eCollaborative/therapeutic assessment: A casebook and guide\u003c/em\u003e (pp. 1\u0026ndash;24). John Wiley \u0026amp; Sons, Inc.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFoucault, M. (1973). \u003cem\u003eThe birth of the clinic: An archaeology of medical perception (A. M. Sheridan Smith, Trans)\u003c/em\u003e. Routledge. (Original work published 1963).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHackmann, C., Wilson, J., Perkins, A., \u0026amp; Zeilig, H. (2019). Collaborative diagnosis between clinician and patient: Why to do it and what to consider. \u003cem\u003eBJPsych Advances\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(4), 214\u0026ndash;222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/bja.2019.6\u003c/span\u003e\u003cspan address=\"10.1192/bja.2019.6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames, P. D., \u0026amp; Cowman, S. (2007). Psychiatric nurses\u0026rsquo; knowledge, experience and attitudes towards clients with borderline PD. \u003cem\u003eJournal of Psychiatric and Mental Health Nursing\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(7), 670\u0026ndash;678. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2850.2007.01156.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2850.2007.01156.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZZ, YY (submitted). I\u0026rsquo;ve Built a Good Life for Myself: A Qualitative Study of Patient-Perceived Change in Transference-Focused Psychotherapy.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJutel, A. (2019). \u003cem\u003ePutting a name to it: Diagnosis in contemporary society\u003c/em\u003e (2nd ed.). Johns Hopkins University.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarterud, S., \u0026amp; Kongerslev, M. T. (2019). Case formulations in mentalization-based treatment (MBT) for patients with borderline personality disorder. In U. Kramer (Ed.), \u003cem\u003eCase formulation for personality disorders: Tailoring psychotherapy to the individual client\u003c/em\u003e (pp. 41\u0026ndash;60). Elsevier Academic Press. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/B978-0-12-813521-1.00003-5\u003c/span\u003e\u003cspan address=\"10.1016/B978-0-12-813521-1.00003-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKendell, R., \u0026amp; Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnoses. \u003cem\u003eAmerican Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e160\u003c/em\u003e(1), 4\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1176/appi.ajp.160.1.4\u003c/span\u003e\u003cspan address=\"10.1176/appi.ajp.160.1.4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKeepers, G. A., Fochtmann, L. J., Anzia, J. M., Benjamin, S., Lyness, J. M., Mojtabai, R., Servis, M., Choi-Kain, L., Nelson, K. J., Oldham, J. M., Sharp, C., Degenhardt, A., Fochtmann, L. J., Oldham, J. M., Hong, S. H., \u0026amp; Medicus, J. (2024). The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. \u003cem\u003eThe American journal of psychiatry\u003c/em\u003e, \u003cem\u003e181\u003c/em\u003e(11), 1024\u0026ndash;1028. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1176/appi.ajp.24181010\u003c/span\u003e\u003cspan address=\"10.1176/appi.ajp.24181010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLester, R., Prescott, L., McCormack, M., Sampson, M., \u0026amp; North West Boroughs Healthcare NHS Foundation Trust. (2020). Service users\u0026rsquo; experiences of receiving a diagnosis of borderline PD: A systematic review. \u003cem\u003ePersonality and Mental Health\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(4), 263\u0026ndash;283. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pmh.1478\u003c/span\u003e\u003cspan address=\"10.1002/pmh.1478\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevitt, H. M. (2020). Reporting standards for qualitative research in psychology: What are they, and why do we need them? In H. M. Levitt, \u003cem\u003eReporting qualitative research in psychology: How to meet APA Style Journal Article Reporting Standards\u003c/em\u003e (Revised Edition, pp. 3\u0026ndash;18). American Psychological Association. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/0000179-001\u003c/span\u003e\u003cspan address=\"10.1037/0000179-001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasland, S. R., \u0026amp; Sharp, C. (2025). Advancing the Science and Reduction of Personality Disorders Stigma: Introduction to a Special Issue of Personality and Mental Health. \u003cem\u003ePersonality and mental health\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(4), e70044. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pmh.70044\u003c/span\u003e\u003cspan address=\"10.1002/pmh.70044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLeod, J., Stiles, W. B., \u0026amp; Levitt, H. M. (2021). Qualitative research: Contributions to psychotherapy practice, theory, and policy. In \u003cem\u003eBergin and Garfield\u0026rsquo;s handbook of psychotherapy and behavior change: 50th anniversary edition, (7th ed.)\u003c/em\u003e (pp. 351\u0026ndash;384). John Wiley \u0026amp; Sons, Inc.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonteith, S., Glenn, T., Geddes, J. R., Whybrow, P. C., Achtyes, E. D., \u0026amp; Bauer, M. (2024). Implications of Online Self-Diagnosis in Psychiatry. \u003cem\u003ePharmacopsychiatry\u003c/em\u003e, \u003cem\u003e57\u003c/em\u003e(2), 45\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1055/a-2268-5441\u003c/span\u003e\u003cspan address=\"10.1055/a-2268-5441\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg, F. Y., Townsend, M. L., Miller, C. E., Jewell, M., \u0026amp; Grenyer, B. F. S. (2019). The lived experience of recovery in borderline PD: A qualitative study. Borderline PD and Emotion Dysregulation, 6, Article 10. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40479-019-0100-1\u003c/span\u003e\u003cspan address=\"10.1186/s40479-019-0100-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Sullivan, S. (2025). \u003cem\u003eWiek diagnozy: Jak obsesja na punkcie zdrowia czyni nas bardziej chorymi [The age of diagnosis: Sickness, health and why medicine has gone too far]\u003c/em\u003e. Znak Literanova.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePerkins, A., Ridler, J., Browes, D., Peryer, G., Notley, C., \u0026amp; Hackmann, C. (2018). Experiencing mental health diagnosis: A systematic review of service user, clinician, and carer perspectives across clinical settings. \u003cem\u003eThe Lancet Psychiatry\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(9), 747\u0026ndash;764. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(18)30095-6\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(18)30095-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRenneberg, B., Hutsebaut, J., Berens, A., De Panfilis, C., Bertsch, K., Kaera, A., Kramer, U., Schmahl, C., Swales, M., Taubner, S., Alvarez, M. M., \u0026amp; Sieg, J. \u0026amp; 30 experts with lived experience \u0026ndash; clients, relatives, significant others - from 10 European countries (2024). Towards an informed research agenda for the field of personality disorders by experts with lived and living experience and researchers. \u003cem\u003eBorderline personality disorder and emotion dysregulation\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40479-024-00257-0\u003c/span\u003e\u003cspan address=\"10.1186/s40479-024-00257-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRentrop, M., Gerra, M. L., \u0026amp; De Panfilis, C. (2025). Transference-focused psychotherapy (TFP) informed psychoeducation. In R. G. Hersh \u0026amp; C. De Panfilis (Eds.), \u003cem\u003eImplementing transference-focused psychotherapy principles\u003c/em\u003e (pp. 49\u0026ndash;82). Springer Nature Switzerland. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-3-031-68062-5_3\u003c/span\u003e\u003cspan address=\"10.1007/978-3-031-68062-5_3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogers, B., \u0026amp; Dunne, E. (2011). They told me I had this PD \u0026hellip; All of a sudden I was wasting their time: PD and the inpatient experience. \u003cem\u003eJournal of Mental Health\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(3), 226\u0026ndash;233. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3109/09638237.2011.556170\u003c/span\u003e\u003cspan address=\"10.3109/09638237.2011.556170\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRose, D. (2010). Service user perspectives on the impact of a mental illness diagnosis. \u003cem\u003eEpidemiology and Psychiatric Sciences\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(3), 241\u0026ndash;247. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1121189X00001186\u003c/span\u003e\u003cspan address=\"10.1017/S1121189X00001186\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSavin-Baden, M., \u0026amp; Howell Major, C. (2013). Qualitative Research: The Essential Guide to Theory and Practice (1st ed.). Routledge. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4324/9781003377986\u003c/span\u003e\u003cspan address=\"10.4324/9781003377986\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchleider, J. L. (2023). The fundamental need for lived experience perspectives in developing and evaluating psychotherapies. \u003cem\u003eJournal of Consulting and Clinical Psychology\u003c/em\u003e, \u003cem\u003e91\u003c/em\u003e(3), 119\u0026ndash;128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/ccp0000801\u003c/span\u003e\u003cspan address=\"10.1037/ccp0000801\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSims, R., Michaleff, Z. A., Glasziou, P., \u0026amp; Thomas, R. (2021). Consequences of a diagnostic label: A systematic scoping review and thematic framework. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e, 725877. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpubh.2021.725877\u003c/span\u003e\u003cspan address=\"10.3389/fpubh.2021.725877\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStoreb\u0026oslash;, O. J., Stoffers-Winterling, J. M., V\u0026ouml;llm, B. A., Kongerslev, M. T., Mattivi, J. T., J\u0026oslash;rgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., \u0026amp; Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. \u003cem\u003eThe Cochrane database of systematic reviews\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(5), CD012955. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/14651858.CD012955.pub2\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD012955.pub2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSulzer, S. H. (2015). Does difficult patient status contribute to de facto demedicalization? The case of borderline PD. \u003cem\u003eSocial Science \u0026amp; Medicine\u003c/em\u003e, \u003cem\u003e142\u003c/em\u003e, 82\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.socscimed.2015.08.030\u003c/span\u003e\u003cspan address=\"10.1016/j.socscimed.2015.08.030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTedesco, V., Day, N. J. S., Lucas, S., \u0026amp; Grenyer, B. F. S. (2024). Diagnosing borderline PD: Reports and recommendations from people with lived experience. \u003cem\u003ePersonality and Mental Health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(2), 107\u0026ndash;121. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pmh.1599\u003c/span\u003e\u003cspan address=\"10.1002/pmh.1599\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimulak, L., \u0026amp; Keogh, D. (2026). Observational Qualitative Psychotherapy Process Research. \u003cem\u003eJournal of Contemporary Psychotherapy\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(1), 1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10879-025-09690-w\u003c/span\u003e\u003cspan address=\"10.1007/s10879-025-09690-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVERBI Software (2024). MAXQDA 2024 (Version 24) [Computer software]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.maxqda.com\u003c/span\u003e\u003cspan address=\"https://www.maxqda.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWerkhoven, S., Anderson, J. H., \u0026amp; Robeyns, I. A. M. (2022). Who benefits from diagnostic labels for developmental disorders? \u003cem\u003eDevelopmental medicine and child neurology\u003c/em\u003e, \u003cem\u003e64\u003c/em\u003e(8), 944\u0026ndash;949. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/dmcn.15177\u003c/span\u003e\u003cspan address=\"10.1111/dmcn.15177\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv category=\"Completeness\" id=\"17\" ruleid=\"MissingTableCitation_01\" status=\"Neutral\" values=\"Table 1\" class=\"btn-xs-small Annotation tooltipped\" data-position=\"top\" data-tooltip=\"\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eCase-level characteristics of study participants\u003c/span\u003e\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"9\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePatient identification\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGender\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEducation\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRelatioship status\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePlace of residence\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLenght of TFP\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDiagnosis disclosure\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eDiagnosis\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e201\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMarried\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 years 3 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e202\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 year 10 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eParanoid and narcissistic PDs, anxiety disorders\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e203\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHigh school\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 years 7 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e204\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e47\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePh.D. and academic degrees\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMarried\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSmall town\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 years 9 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e205\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 year 10 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e206\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBachelor\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 year\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e302\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 years 7 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline and narcissistic PDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e208\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBachelor\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRural area\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 years 4 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e210\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVocational school\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 years 2 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMixed PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e303\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e46\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMarried\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e9.5\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNarcissistic PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e304\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e49\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 years 8 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eHistrionic PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e207\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e42\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 years 10 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNarcissistic PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e301\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026apos;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eRural area\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 years 3 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline PD\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 year\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline, narcissistic, paranoid PDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSecondary education\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 years\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eInformal relationship\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e7 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePersonality depression\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e305\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e31\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMaster\u0026rsquo;s degree\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eSingle\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLarge city\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 months\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c9\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBorderline and narcissistic PDs\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eNote.\u003c/span\u003e Place of residence was categorized as small town (5,000\u0026ndash;50,000 inhabitants), medium-sized city (50,000\u0026ndash;200,000 inhabitants), and large city (\u0026gt;\u0026thinsp;200,000 inhabitants).\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-contemporary-psychotherapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocp","sideBox":"Learn more about [Journal of Contemporary Psychotherapy](http://link.springer.com/journal/10879)","snPcode":"10879","submissionUrl":"https://submission.springernature.com/new-submission/10879/3?","title":"Journal of Contemporary Psychotherapy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"personality disorders, diagnosis disclosure, patient experience, Transference-Focused Psychotherapy, qualitative research, thematic analysis","lastPublishedDoi":"10.21203/rs.3.rs-9321171/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9321171/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eDisclosure of a personality disorder (PD) diagnosis is a clinically sensitive moment that may influence patients\u0026rsquo; engagement with treatment, identity, and therapeutic relationships. Despite its importance, little is known about how patients themselves experience and interpret this process within specialized psychotherapies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe present study explored how patients in Transference-Focused Psychotherapy (TFP) experience and make sense of receiving a PD diagnosis. Using a qualitative design, we analyzed written accounts from 17 patients engaged in TFP. Data were examined using reflexive thematic analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eParticipants described diagnostic disclosure as a complex and emotionally charged experience that evoked a wide range of reactions, including fear, relief, curiosity, and validation. Most reported an ambivalent relationship to the diagnosis, with its meaning evolving over time through therapeutic work and reflection. Six themes captured how patients understood and integrated the diagnosis into their therapeutic experience. For many, the diagnosis initially disrupted self-narratives and was experienced as an external verdict; however, over time it often became a framework that helped organize distress, support self-understanding, and guide therapeutic change. The relational context of disclosure emerged as central: when communicated within a supportive therapeutic relationship, the diagnosis was more often experienced as meaningful and containing rather than stigmatizing.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings suggest that diagnostic disclosure in PD treatment functions not merely as the communication of clinical information but as a relational and meaning-making process embedded in psychotherapy. Understanding patient experiences may help clinicians approach diagnostic discussions in ways that support engagement, reflection, and therapeutic collaboration.\u003c/p\u003e","manuscriptTitle":"Disclosing the Diagnosis in Personality Disorder Treatment: Patient Experiences in Transference-Focused Psychotherapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-19 07:56:56","doi":"10.21203/rs.3.rs-9321171/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-15T14:33:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T06:53:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"53419858329470658792340073263705138170","date":"2026-04-12T01:04:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-08T14:03:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-08T03:46:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-08T03:45:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Contemporary Psychotherapy","date":"2026-04-04T14:19:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-contemporary-psychotherapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jocp","sideBox":"Learn more about [Journal of Contemporary Psychotherapy](http://link.springer.com/journal/10879)","snPcode":"10879","submissionUrl":"https://submission.springernature.com/new-submission/10879/3?","title":"Journal of Contemporary Psychotherapy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7b07c341-a1ee-4c32-a5f1-6e80f43e09fb","owner":[],"postedDate":"April 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-08T19:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-19 07:56:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9321171","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9321171","identity":"rs-9321171","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}