An Update and Overview of the Empirical Evidence for Transference-Focused Psychotherapy and Other Psychotherapies for Borderline Personality Disorder (original) (raw)
Related papers
The Interpretive Process in the Psychoanalytic Psychotherapy of Borderline Personality Pathology
Journal of the American Psychoanalytic Association, 2009
While all patients become more concrete in their psychological functioning in areas of conflict, especially in the setting of transference regression, in the treatment of patients with severe personality pathology this process poses a particular clinical challenge. In the psychoanalytic psychotherapy of patients with severe personality pathology in general, and borderline personality disorder in particular, the interpretive process serves multiple functions. This process comprises a series of steps or phases that can be viewed as moving the patient further away from a single, poorly elaborated, and concrete experience in the transference, which dominates and floods subjectivity, and toward more fully elaborated, complex, stable, and integrated representations of the analyst and of what he or she evokes in the patient's internal world.
Studies in Medical Sciences, 2020
Background & Aims: The purpose of the present study was to investigate the changes in borderline personality structure at different time serials of treatment. Materials & Methods: The present study is a quasi-experimental and single-subject (A/B) study. The sample of study was a 35-year-old man who was selected as a borderline personality disorder among the patients referred to Health Center through a preliminary clinical interview and performing Millon clinical multiaxial inventory -III (MCMI-III) by available sampling method. The interview with the Semi-Structured Interview of the Personality Organization (STIPO) was conducted in four stages including one pre-test and three post-tests after time series treatment. Single-Subject was studied for 11 months in a format of 51 sessions of transference focused psychotherapy. Results: The findings showed that the mean scores of personality structure (identity, dimensions of object relations, aggression, personality rigidity, deference mechanisms, and morality) in the first post-test were not significantly different from the pre-test; but there was a significant clinical difference in the mean scores of personality structure at the second and third post-tests compared to the pre-test. Conclusion: Based on the results, this treatment has significant effect in improving the personality dimensions of borderline patients, especially in advanced stages of treatment.
Journal of Infant Child and Adolescent Psychotherapy, 2015
A brief overview of transference-focused psychotherapy (TFP), developed by Otto F. Kernberg for the treatment of clients with severe personality disorders, is presented. The therapy begins with the development of a treatment contract, which consists of general guidelines that apply for all clients and with specific items developed from problem areas from the individual client's history that could interfere with the therapy process. The contract also contains therapist responsibilities. The client and therapist must agree to the content of the treatment contract for therapy to proceed. The client's affectively charged internal representations of previous relationships are consistently interpreted as the therapist becomes aware of them in the therapeutic relationship, that is, the transference. There are specific strategies and techniques used in TFP; however, more important are the guiding principles used throughout the treatment. A case is presented to illustrate aspects of this therapy as applied to a client with borderline personality disorder (BPD).
Dialogues in Clinical Neuroscience & Mental Health 4 (2), 91-104, 2021
Borderline personality disorder (BPD) is a persistent pattern of instability in terms of emotion regulation, impulsiv-ity, self-image, interpersonal relationships with extreme 'splitting' between idealisation and devaluation of others, including also stress-related paranoid ideation and dissociative symptoms. Self-harming behaviour is also common amongst BPD patients. The manifestation of these symptoms may lead to serious disturbances of quality of life for patients, families and their significant others along with problems in professional and personal development. Several evidence-based psychotherapeutic approaches have been developed to address these issues. In this review two of them were put into scrutiny; Dialectical Behaviour Therapy or DBT, and Transference-Focused Psychotherapy or TFP. These were reviewed by examining RCT studies published in Cochrane and Clinicaltrials.gov databases. The efficacy of these two interventions was examined on similar outcomes, such as therapy dropout, general BPD symptoms, global functioning, self-harm, and social adaptation. No prominent superiority for either of the treatments in comparison was identified, however both TFP and DBT show greater efficacy when compared to other, non-BPD specific psychotherapeutic approaches.
British Journal of Psychiatry, 2010
Transference-focused psychotherapy was developed by Otto F. Kernberg and is based on his model of borderline personality disorder. 1,2 The efficacy of transference-focused psychotherapy has been evaluated in two randomised controlled trials (RCTs) to date. A 1-year RCT 3 with 90 participants with borderline personality disorder compared transference-focused psychotherapy with dialectical behaviour therapy 4 and psychodynamic supportive therapy. All three groups showed significant positive change in depression, anxiety, global functioning and social adjustment in a multiwave design. Transference-focused psychotherapy and dialectical behaviour therapy were associated with a significant improvement in suicidality, transference-focused psychotherapy and supportive therapy improved facets of impulsivity and only the former yielded a significant improvement in anger, irritability and verbal and direct assault. Moreover, only those individuals in the transference-focused psychotherapy group improved significantly in their reflective function and their attachment style. 5 Giesen-Bloo et al 6,7 compared transference-focused psychotherapy to schema-focused therapy 8 in a 3-year RCT with 88 participants with borderline personality disorder. The transference-focused psychotherapy revealed a significantly higher drop-out rate (51.2% v. 26.7%) and -despite improvements in all domains of outcome -significantly smaller treatment effects. The American Psychological Association (Division 12) evaluated transference-focused psychotherapy as having controversial research support. Thus, more research is needed before transference-focused psychotherapy can be considered to have modest or strong research support. The present study aims to bring clarity to the field and to determine whether transference-focused psychotherapy can be regarded as empirically supported treatment according to the American Psychological Association (Division 12) criteria. 10 This investigation examines the efficacy of transference-focused psychotherapy for borderline personality disorder in an RCT comparing those randomised to transference-focused psychotherapy with those randomised to a group treated by experienced psychotherapists in the community.
Clinical Psychology Review, 1991
A pathology of affect regulation and of object relations (the cognitive and affective processes that mediate interpersonal functioning in close relationships) are two features that define much of borderline pathology. Cognitive-behavioral interventions that target self-regulation and social-cognitive processes (such as perspective-taking and attribution) can be usefully integrated into psychodynamically oriented treatment of borderline patients. Strictly psychodynamic approaches tend to be limited by factors such as a lack of attention to processes by which conscious insight and coping strategies can be transformed into automatic or adaptive unconscious procedures in these patients. Cognitive approaches tend to be limited by rationalistic assumptions about motivation and an underestimation of the complexities of cognitive-affective interactions and unconscious processes. If researchers and clinicians who study borderline personality disorders (BPD) agree on one thing, it is that treatment of these patients is extremely difficult and frequently unsuccessful (see Waldinger, 1987). Waldinger and Gunderson (1984) found that, for borderline patients of experienced clinicians, only half continued in treatment beyond six months, only one-third completed treatment, and the majority terminated against their therapist's advice.2 Pharmacotherapy for borderline patients can sometimes be helpful, especially when used adjunctively with psychotherapy. However, medication typically produces modest results, sometimes generates unwanted effects [such as behavioral dyscontrol or impulsivity 'A version of this article was presented at the Third Annual Convention of the Society for the Exploration of Psychotherapy Integration, Chicago, IL, May, 1987. 'What is particularly sobering about these findings is that these patients were apparently relatively high-functioning borderlines, treated in private practice as outpatients, and that their therapists were largly clinicians who have made important contributions to the borderline literature.