Kramer 2014.

Study characteristics
Methods	10‐session trial with 2 arms (endpoint data): General psychiatric management (GPM) Motive‐oriented therapeutic relationship (MOTR) Duration of trial: 10 sessions Country: Switzerland Setting: Outpatient
Participants	Method of recruitment of participants: not stated Sample size: 85 Diagnosis of borderline personality disorder: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV) Means of assessment: DSM‐IV diagnoses of borderline personality disorder were established by trained clinicians or clinician researchers for all patients using the Structured Clinical Interview (SCID‐II) for DSM‐IV Mean age: GPM = 30.95 years (standard deviation = 11). MOTR = 34.64 years (standard deviation = 9.97) Sex: 68.2% female Comorbidity: current DSM‐IV diagnoses; depressive disorder = 56/74, anxiety disorder = 13/74, eating disorder = 10/74, substance abuse = 54/74, intelligence limitation = 6/74, sexual disorder = 9/74, attention disorder = 4/74. Axis II cluster A = 11/74, Axis II cluster B = 23/74, Axis II cluster C = 12/74 Inclusion criteria Presence of a DSM‐IV diagnosis of borderline personality disorder Aged between 18 and 65 years old at time of recruitment Exclusion criteria Presence of a DSM‐IV diagnosis of psychotic disorder, with mental retardation and substance abuse at the forefront. Minimal exclusion criteria were formulated in order to increase the external validity of the trial.
Interventions	Experimental group Treatment name: GPM Number randomised to group: 43; analysis on 38 only Duration: 10 sessions; no further information Concomitant psychotherapy: not stated Concomitant pharmacotherapy: 23/38 (61%) Control/comparison group Comparison name: MOTR Number randomised to group: 42; analysis on 36 only Duration:10 sessions; no further information Concomitant psychotherapy: not stated Concomitant pharmacotherapy: medication use at baseline: MOTR group 23/38 (61%), TAU group 21/36 (58%); χ2=.04, P = 0.84 Proportions of participants taking standing psychotropic medication during trial observation period: unclear
Outcomes	Primary Borderline personality disorder severity, assessed by the Borderline Symptom List (BSL‐23) Psychosocial functioning, assessed by the social role subscale of the Outcome Questionnaire – 45.2 (OQ‐45) Secondary Interpersonal problems, assessed by the social role subscale of the OQ‐45 Attrition, in terms of patients lost after randomisation in each group
Notes	Sample size calculation: yes Ethics approval: The research protocol was approved by the local ethics board (clearance number 254/08), as well as the research committee of the university department. Comments from review authors: All demographic data were based on the 74 participants who completed the trial. Missing data on the 11 participants who dropped out before the session were not reported.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Comment: randomisation was performed using an internet‐based block randomisation program; sealed envelopes were prepared by an independent researcher and opened when the patient accepted the study (p 179).
Allocation concealment (selection bias)	Low risk	Comment: sealed envelopes were prepared by an independent researcher and opened when the patient accepted the study (p 179).
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: no information regarding blinding of outcome assessors
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: 11 participants dropped out before session two. No reasons provided. No reasons provided either for the 14 who discontinued the treatment. No demographic data on the entire sample (number of participants = 85). Imputation method used = LOCF
Selective reporting (reporting bias)	High risk	Comment: Working Alliance Inventory – Short Form, a self‐report questionnaire was presented in the full report but there was no mention of this outcome in protocol.
Other bias	High risk	Treatment adherence Comment: adherence was assessed at the end of each of the 40 treatments (see p 180). Attention bias Comment: nothing found Allegiance bias Ueli Kramer, Franz Caspar & Martin Drapeau are all heavily linked to MOTR. Vested interest Comment: nothing found