Transference Interpretation in the Psychotherapy of Borderline Patients: A High-Risk, High-Gain Phenomenon (original) (raw)
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Psychodynamic Psychotherapy Research, 2011
It is generally believed that psychoanalytically or dynamically oriented clinicians are not interested in research for a host of reasons ranging from the challenges of designing a randomized controlled trial that would demonstrate the effi cacy of a psychoanalytic approach to epistemological and philosophical disagreements about the nature of science (see debates for an illustration). Although many in the psychoanalytic community have in the past been cautious regarding the value of research, some of the earliest psychotherapy research was performed by psychoanalysts . Additionally, psychoanalyst and psychodynamic clinicians are increasingly becoming interested in testing psychodynamic hypotheses and establishing a stronger evidence base for treatments based on psychodynamic ideas . This increased interest in psychotherapy outcome research has been particularly fruitful with regard to the study of borderline personality disorder. Severe personality disorders such as borderline personality disorder are increasingly seen as the mainstay of psychoanalytic clinical work.
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.
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.
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).
An Integrative Perspective on Psychotherapeutic Treatments for Borderline Personality Disorder
Journal of Personality Disorders, 2008
Although there is an abundance of literature on the psychotherapeutic treatment of borderline pathology, little is known about differences and similarities between treatments of borderline personality disorder (BPD). Potential differences and similarities are especially important in the absence of evidence of the superiority of one treatment over the other (e.g., Livesley, 2004). This article offers an overview of the theory and practice of contemporary psychotherapeutic treatments of BPD, and delineates similarities and differences between the specific treatments. Results show that similarities concerning (1) the formal characteristics, and (2) the importance of therapeutic techniques in treatments for BPD, outnumber the differences. This article concludes by viewing the similarities and differences from an integrative perspective, and recommendations are given for future work in treating patients with and research on the effectiveness of treatments and treatment techniques for BPD. From Universiteit van Amsterdam. The authors would like to thank Dawn Bales,
Psychotherapy with borderline patients: I. A comparison between treated and untreated cohorts
Australian and New Zealand Journal of Psychiatry, 1999
Borderline personality disorder (BPD) is a serious mental illness, with a mortality which approaches 10% . An American study suggests that over 20% of psychiatric inpatients and about 10% of psychiatric outpatients can be given this diagnosis. Although once considered 'unanalysable' and so beyond the therapeutic pale, cautious optimism has arisen following recent reports of treatment outcome in this condition . However, although the mor-bidity associated with BPD generates heavy expenditure and is a considerable burden on health services, scepticism about treatment effects persists within health bureaucracies since adequately designed studies in this area are few.