Journal of Cognitive Psychotherapy: An International Quarterly Volume 22, Number 3 • 2008 250 © 2008 Springer Publishing Company DOI: 10.1891/0889-8391.22.3.250 Treatment Attitude and Therapy Outcome in Patients With Borderline Personality Disorder Amy Wenzel, PhD University of Pennsylvania Elizabeth L. Jeglic, PhD John Jay College of Criminal Justice Hollie J. Levy-Mack, MSW Aaron T. Beck, MD Gregory K. Brown, PhD University of Pennsylvania This study investigated the degree to which two ways of defining attitude toward treatment (i.e., attitude toward talking with a therapist about problems, expectation for improvement) predicted therapy outcome. The sample consisted of 28 patients who participated in an open clinical trial evaluating the efficacy of cognitive therapy for borderline personality disorder and who completed assessments at baseline and 12-month follow-up (Brown, Newman, Charlesworth, Crits-Cristoph, & Beck, 2004). When attitude toward treatment was defined as attitude toward talking with a therapist, this variable predicted suicide ideation and scores on two measures of depression at the 12-month assessment. When attitude toward treatment was defined as expectation for improvement, this variable predicted scores on one measure of depression and number of borderline personality disorder criteria met at the 12-month assess- ment. These results provide preliminary evidence that positive attitudes toward treatment are associated with more clinical improvement, although future research should replicate this finding with a better developed measure of treatment attitudes. Keywords: borderline personality disorder; treatment attitude; treatment expectations; treatment outcome B orderline personality disorder (BPD) is the most common personality disorder observed in psychiatric settings, with approximately 20% of patients in inpatient units and 11% of patients in community mental health clinics carrying the diagnosis (Swartz, Blazer, & George, 1990). Because of the complexity and chronicity of this disorder, BPD has come to be viewed by clinicians as one of the most difficult mental illnesses to treat (Markham, 2003). One major area of investigation in the treatment of patients with BPD is the manner in which the patient–therapist relationship affects outcome (e.g., Livesley, 2000, Robins, Ivanoff, & Linehan,