The perspectives of patients, significant others, and therapists on factors that impede treatment for personality disorders: A concept map study.

Despite the availability of effective treatments for personality disorders (PDs), recovery rates are modest. A better understanding is therefore needed of what patients, significant others and therapists consider to be impediments to PD treatment. We used concept mapping to create a conceptual framework of factors that impede PD treatment. The perspectives of patients, significant others, and therapists with respect to impediments were collected in brainstorm sessions and then formulated as statements by an expert team. The participants subsequently prioritized and sorted these statements prior to analysis with multidimensional scaling and grouping on a two-dimensional concept map using hierarchical cluster analyses. Fifty-four statements were defined and assigned to 11 clusters that were grouped in five metaclusters: (a) lack of trust in the therapeutic relationship, (b) perceived therapist incompetence (c) shortcomings in the mental health care system, (d) patient-related conflicting factors, and (e) insufficient involvement of significant others. This study provides a conceptual framework of factors that are perceived to impede PD treatment. Our findings potentially contribute to an awareness of impediments in clinical practice and suggest that therapists should actively inquire about the expectations, needs, and treatment difficulties of patients and their significant others. (PsycInfo Database Record (c) 2026 APA, all rights reserved).