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"The Analyst's Vulnerability: Impact on Theory and Practice" by Karen J. Maroda is a book that presents the author's vision of psychoanalysis, specifically relational psychoanalysis, which emphasizes the importance of the analyst's vulnerability and personal experiences in the therapeutic process. The book explores the limitations of traditional psychoanalytic approaches, such as neutrality and anonymity, and argues for a more humanistic and interactive approach to therapy. While the author's perspective may not resonate with everyone, the book offers valuable insights and prompts readers to reflect on the role of the analyst in the therapeutic relationship. [Extracted from the article]

Individuals with borderline personality disorder (BPD) struggle to identify whom they can safely trust, and this struggle contributes to profound emotional turmoil in their close relationships. Transference-focused psychotherapy (TFP) is an application of object relations theory (ORT) that posits that polarized mental representations of self and other define the personality organization of BPD. TFP aims to utilize a clear treatment frame coupled with an analysis of the therapeutic relationship (i.e., the transference) to help individuals with BPD integrate their polarized mental representations. Improvement in the capacity to trust others is inherent in the mechanisms of change in TFP. In this article, a social cognitive model of trust processing provides a new lens through which we formulate how TFP may enhance trust processing in BPD. Recent evidence from randomized clinical trials supports the argument that TFP may intervene with BPD in a way that is concordant with uniquely improved trust processing. [ABSTRACT FROM AUTHOR]

Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed. [ABSTRACT FROM AUTHOR]

The article discusses Joseph Fernando's book, "A Psychoanalytic Understanding of Trauma," which offers a specific approach to examining trauma based on different unconscious processes. The book explores the concept of the zero process, which explains the mental shutdown that occurs in extreme traumatic situations. Fernando differentiates trauma from other psychopathologies and emphasizes the importance of addressing traumatic repetitions and their defenses directly in therapy. The article praises Fernando's work as a significant contribution to the literature on trauma and suggests that it will lead to improved treatment methods. [Extracted from the article]

Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice. [ABSTRACT FROM AUTHOR]

A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness. [ABSTRACT FROM AUTHOR]

This article presents my responses to two Commentaries on my DBT case of "Jane" (Marks, 2022): one by Gillian Galen, Blaise Aguirre, and Julianne Wilner Tirpak (2022); and one by Allison Ruork (2022). While both Commentaries acknowledge that my therapy with Jane was ultimately quite helpful to her, both point to the turbulent and conflictual nature of a substantial portion of our therapeutic relationship. Galen et al. attribute this struggle in part to the DBT equivalent of "countertransference" dynamics in my therapeutic relationship with Jane; and Ruork attributes this struggle in part to my under use of the DBT concept of "secondary targets." I found both of these perspectives very on target, and they stimulated me to reconstruct a crucial theme in the therapy from excerpts of therapy process in sessions 14-24 of my case study of Jane. I end the article by reflecting on the value of writing up systematic case studies with sufficient descriptive clinical detail so that valuable secondary analyses can be conducted, like those by Galen et al., by Ruork, and by me based on the former two. [ABSTRACT FROM AUTHOR]

Objective: This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviors expressed or experienced by therapists toward their patients. It aims to understand the patterns of countertransference experienced in working with borderline personality disorder. Associations between countertransference reactions and therapist-related variables of experience and mentalization ability are also examined. Method: Psychotherapists (n = 117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization, and motivation to mentalize. Results: The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective, and helpless/inadequate. More experienced therapists reported less negative countertransference reactions in select dimensions. Therapists' self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others' mental states, the motivation to mentalize, and the strength of their countertransference reactions. Conclusion: The implications for countertransference management as well as therapist training and development are highlighted. [ABSTRACT FROM AUTHOR]

Repetitive self-mutilation or non-suicidal self-injury (NSSI) refers to the intentional destruction of one’s own body tissue without suicidal intent and for purposes not socially sanctioned. Common examples include cutting, scratching, and hitting. Although NSSI generally has been considered a characteristic symptom of borderline personality disorder, its onset and prevalence typically occur in mid-adolescence, whereas the typical onset of borderline personality disorder is in early adulthood. Therefore, NSSI should be considered separately from borderline personality, but also from a psychodynamic perspective. From the classical psychoanalytic viewpoint, self-mutilation is associated with the failure to control aggressive drives. In ego psychology, self-mutilation is seen as an attempt of the fragile ego to re-establish boundaries with the external environment and avoid being overcome with uncontrollable emotions. In object-relation theory, it is seen as an effort to reconstruct unclear boundaries between ego and object or ego and reality by cutting the skin-the fundamental separation between them. Self-mutilation- can interfere with the psychotherapy by increasing or decreasing transference or causing strong countertransference. The therapist might experience helplessness or anger at repetitive self-mutilations and, with an adolescent patient, might be conflicted about telling the facts to parents or maintaining the patient’s confidentiality. In conclusion, consideration of various psychodynamic aspects is important in understanding and treating patients with NSSI. [ABSTRACT FROM AUTHOR]

Fragmented narratives, half-phrases, silences, and affect states that populate the consulting room can be understood through Jung's notion of the prospective function. These halting affect-laden phrases reveal the taboo around psychological integration in a certain population. Using Carl Jung, Donald Winnicott, Ann Ulanov, and James Grostein, this article analyzes the space of not-knowing or, said another way, of knowing from another source, a source for which the location is found in the void and emerges through desire. I term this knowing from another source yonic knowing. In this article, I discuss the current "epidemic" of those being diagnosed with borderline personality disorder in relation to the prospective function of fragmentation, arguing for a new kind of consciousness found within these dissociated states of being that emerges through the void [ABSTRACT FROM AUTHOR]

Kernberg's structural interview integrates exploration of elements of personality organization into the standard initial psychiatric evaluation. The structural interview approach, while essential to transference-focused psychotherapy for patients with borderline personality disorder, is not limited to use in that context. Following the model of the structural interview, clinicians ask a series of questions, which elucidate elements of personality pathology, thereby facilitating comprehensive diagnosis, guiding treatment, and informing prognosis. Direct questioning about finances and the clinician's general curiosity about issues related to money, in the context of the structural interview, can be high-yield lines of inquiry. Patients' history with their finances, attitudes about money, and ways questions about finance emerge in the transference around fees and related concerns, can add an important, often overlooked, dimension to the assessment of personality organization and personality disorder pathology. This article proposes the utility of prioritizing questions regarding money, as might be integrated into the structural interview, as a template for a broader recognition of the value of this line of inquiry in a diagnostic assessment process. [ABSTRACT FROM AUTHOR]

Over the course of a 40-year career as a Jungian analyst, Giles Clark became an influential figure in both England and Australia, where he emigrated in 1995. Giles and Neil Micklem were the other Zurich graduates; Sheila Powell, Mary Williams and Andrew Samuels came from the SAP. At that time, ANZSJA's training was arranged regionally, with responsibility for the content and structure of the training being left to local analysts. Jim was a patient with whom Giles worked for eight years before leaving for Australia, and whom he wrote about in several of his later papers. [Extracted from the article]

Risk management challenges in psychiatry are made more complicated when they involve the treatment of patients with primary or co-occurring personality disorder pathology. Principles of transference-focused psychotherapy (TFP), a treatment empirically validated for borderline personality disorder (BPD) and with utility for patients with varying personality disorder presentations, are practical, commonsense measures that can guide clinicians in these difficult matters. Applied TFP principles are useful in this area even when clinicians are not engaged in an extended individual psychotherapy. Central to the TFP approach are: (1) an openness to identifying personality disorder pathology; (2) a deliberate process to assess personality disorder diagnoses with attention to severity of illness; (3) an emphasis on the informed consent process, which includes sharing fully with the patient the clinician's diagnostic impression with germane psychoeducation; (4) an expectation for timely contacts at the outset of treatment with prior practitioners and with family members, when indicated; and (5) the development and maintenance of a treatment frame. TFP stresses the active monitoring of three channels of communication (what the patient says, how the patient behaves, and the clinician's countertransference) as a guiding precept that informs clinical decision-making. TFP principles can serve as a useful risk management "checklist" by organizing a clinician's approach to inherently confounding material. [ABSTRACT FROM AUTHOR]

The objective of this work is to analyze the scientific literature production on borderline personality disorder in Spain over the 2010-2015 period, making a comparative study of articles collected from scientific journals in the field of psychology from several perspectives: year of publication, type of journal (indexing), type of study, clinical sample and main topic. After the analysis of 80 articles obtained in WOS, Scopus, Psicodoc, Dialnet, and ISOC databases, it was found that most analysis units appear in type C and D publications in adult population and in theoretical studies, being the prevailing subject different psychotherapeutic strategies, especially Dialectic-Behavioral and Transference-Focused Therapy, although with increasing trends of new procedures applied to BPD population. The scarcity of publications on topics such as psychopharmacological and etiological studies, design of new measuring instruments, or differential diagnosis deserves special attention. [ABSTRACT FROM AUTHOR]

Recalling his own participation in a daily group seminar with Rosenfeld and taking this experience as his starting point, the Author describes and discusses the later Rosenfeld’s approach to working with severely disturbed narcissistic patients. Through a detailed analysis of a supervision of a session with a psychotic patient, this paper essentially highlights how important it is to construct a (cognitive and affective) basic common ground in order to subsequently proceed to interpretations of transference. In particular, the paper brings to light those elements allowing the creation of that basic cognitive-affective ground that is necessary to profitably (in a manner useful to the patient) connect the relational events narrated and acted by the patient with thehic et nuncof analytic interaction. [ABSTRACT FROM AUTHOR]

Aims: Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP. Methods: BPD subjects (n = 10) were scanned preand post-TFP treatment using a within-subjects design. A disorder-specific emotional-linguistic go/no-go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control. Results: Analyses demonstrated significant treatment-related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior-medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post-treatment improvements in constraint were predicted by pre-treatment right dorsal anterior cingulate cortex hypoactivation, and pre-treatment left posterior-medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability. Conclusions: These preliminary findings demonstrate potential TFP-associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy. [ABSTRACT FROM AUTHOR]

Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment. [ABSTRACT FROM AUTHOR]

Objective: This article discusses Transference-Focused Psychotherapy, a contemporary evidence-based and manualised form of psychoanalytic psychotherapy for borderline personality disorder. Transference focused psychotherapy has evolved from decades of research in the object-relations approach developed by Professor Otto Kernberg and his collaborators. It is being adopted increasingly throughout North and South America and Europe, and this article explores the role its adoption might play in psychiatric training as well as public and private service provision contexts in Australia.Conclusions: Transference focused psychotherapy is readily applicable in a range of training, research and public and private service provision contexts in Australia. A numbers of aspects of current Australian psychiatric training and practice, such as the Royal Australian and New Zealand College of Psychiatrists advanced training certificate, and the Australian medicare schedule, make it especially relevant for this purpose. [ABSTRACT FROM AUTHOR]

This review aimed to explore the evidence base of psychodynamic therapy for personality disorder (PD). A systematic approach was applied to the literature search with the use of a clear inclusion/exclusion criteria and a quality assessment checklist. Nineteen studies investigating the use of psychodynamic therapy for PD were reviewed. Four randomised controlled trials (RCT) demonstrated superior results for psychodynamic therapy compared with another type of therapy, two RCTs found that cognitive-based therapies were superior and one RCT found no difference between therapies for PD. Another seven RCTs found positive results for psychodynamic therapies compared with a treatment as usual condition (n = 3) or another dynamic therapy (n = 4). Five non-RCTs were included with mixed findings for treating PD with psychodynamic therapy. Many of the included studies focusing on psychodynamic-based therapies with borderline personality disorder had positive outcomes, and concentrated on mentalisation-based therapy and transference-focused therapy. There were good outcomes for short- and long-term psychodynamic therapies with individuals with PD. Implications for developing services for treating PD are discussed. Research that addresses methodological issues and increases understanding of the ingredients of change in psychodynamic therapy for PD is also recommended. [ABSTRACT FROM AUTHOR]

A number of leading practice models have been found to be effective in the treatment of Borderline Personality Disorder (BPD). These include Dialectical Behavior Therapy, Transference Focused Psychotherapy and Mentalization Based Treatment. This article reviews the current evidence for these dominant practice models, and concludes that no single treatment has been found to be consistently superior in the treatment of BPD. Given the lack of evidence priviledging one single model of treatment, and the fact that it is not always feasible or desirable for social workers to practice using pure manualized treatment models, there is a need to develop more integrative approaches to treatment with this vulnerable population. By highlighting specific similarities and differences between practice techniques, this paper attempts to pave the way toward developing a more integrative treatment approach to working with individuals with BPD, an approach where interventions are selected based on appraisal of the evidence, clinical expertise, and client need. [ABSTRACT FROM AUTHOR]

Despite significant changes to policy, legislation and treatment pathways for people with borderline personality disorder in recent years, stigma and prejudice towards this client group remain ingrained in mental health services. This article explores the notion of therapeutic pessimism and other possible reasons why attitudes remain unchanged. In considering the benefits of dialectical behaviour therapy for those with borderline personality disorder, it offers suggestions for improving service provision and for developing a more optimistic approach to care. [ABSTRACT FROM AUTHOR]

Clinical experience involving the treatment of patients with comorbid borderline and narcissistic personality disorders suggests that this patient population is among the more difficult to treat within the personality disorder spectrum. In this article, we present refinements of Transference Focused Psychotherapy (TFP) based on our clinical experience with and research data on patients with comorbid narcissistic personality disorder/borderline personality disorder (NPD/BPD). We briefly review object relations formulations of severe narcissistic pathology, as well as recent research in attachment and the allied concept of mentalization, which have provided a new lens through which to view narcissistic disorders. The research findings from two randomized clinical trials demonstrating the efficacy and effectiveness of TFP are presented. The data from the two Randomized Clinical Trials (RCT) allowed for the study of the characteristics of the subgroup of borderline personality disorder patients who have comorbid NPD/BPD. Findings on comorbidity, attachment status, capacity for mentalization, and level of personality organization of borderline patients with comorbid NPD/BPD, compared with borderline patients without comorbid narcissistic pathology (BPD), are presented. Clinical implications of the observed group differences are discussed, with a focus on refinements in the technique of TFP. Clinical case material is presented to illustrate the specific challenges posed by narcissistic patients to carrying out TFP in each phase of treatment. [ABSTRACT FROM PUBLISHER]

Individuals with borderline personality disorder ( BPD) appear more likely than individuals with other mental disorders to evoke negative countertransference reactions. The current study examined countertransference toward BPD across client- (e.g., client age and gender) and clinician-level (e.g., age, discipline, clinical experience, training) factors. Participants ( N = 560) completed an anonymous online survey in which they read case information describing a client with BPD and answered questions to assess their reactions toward the client. The study used a 2 × 2 between-subjects design in which client age and gender were experimentally manipulated. Despite receiving the same vignette, clinicians were more accurate in diagnosing the female client with BPD than the male client, and clinician reactions differed as a function of client age and clinician experience. Specifically, clinicians viewed adolescent clients with BPD as less ill, less trustworthy, and more dangerous than adults with BPD; more clinical experience among clinicians was associated with more positive reactions to clients. Findings help to better understand countertransference reactions and the ways they may impact diagnostic choices and treatment decisions. The implications of these findings for facilitating better clinician-client matching, reducing clinician burnout, and improving treatment experiences for individuals with BPD are discussed. [ABSTRACT FROM AUTHOR]

The article presents Chapter Eleven of the book "Klein in the Trenches: Working With Disturbed Patients," by Robert Waska. It highlights the role of analytic observation in facing off transference of borderline, narcissistic, and neurotic patients as it explains how they use place, control, or view one's self and object. Moreover, the case material shows that patients are more open to hearing interpretations about the meaning and nature of their acting out and anxiety.

Transference is seen as an important change mechanism in psychotherapeutic technique, although questions remain about its therapeutic use, especially with borderline personality disorder (BPD) patients. This article illustrates the lively debate about transference interpretation through the perspective of two psychotherapeutic techniques under empirical scrutiny-transference-focused psychotherapy (TFP) and mentalization-based treatment (MBT). Each technique offers a similar understanding and appreciation of transference, but they differ in their technical use of this change mechanism. The article presents a brief case study of a BPD patient. The treatment highlights the utility of each psychotherapeutic technique in understanding the developmental progress made by the patient in therapy. The authors argue that each technique may be useful in a long-term dynamic therapy, and that one can use an epigenetic framework to understand this observation. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on the use and analysis revivification of dream analysis in psychodynamic psychotherapy of severely disordered patients. The author mentions that the dreams of the patients serves as the transference-related material in the absence transference material acting through strong emotion. The author also discusses the three levels of discourse of a patients' dream such as here-and-now, distant past, and transference.

Clients with borderline personality disorder are viewed as difficult to work with. They also have high drop-out rates and unpredictable treatment outcomes. The characteristics of patients with borderline personality disorder often have a negative effect on the therapeutic process and on clinicians themselves. Challenges are likely magnified for trainee psychologists, given their lack of experience in implementing treatment plans and their inadequate understanding of underlying dynamics. However, to date, no studies have focused on the particular challenges experienced by trainee psychologists. This article attempts to address the gap in literature by exploring the difficulties experienced by a trainee psychologist in treating a patient with borderline personality disorder. A case study is used to highlight the challenges experienced by a novice psychologist in using specific therapeutic modalities recommended in the treatment of borderline personality disorder (BPD), namely dialectical behaviour therapy (DBT) and mentalisation based therapy (MBT). The aim of the study was to help better identify, understand and normalise the countertransference experiences and other difficulties experienced by trainee psychologists in treating clients with BPD. The article highlights observations regarding the context of the supervisory process, the importance of personal psychotherapy, the potential for harm of pejorative views, and the complications arising from a mismatch between the treatment modality and the treatment context. [ABSTRACT FROM PUBLISHER]

In recent decades, with the emergence of postmodern philosophies and of relational psychoanalysis, therapeutic neutrality has come under challenge as being both an impossible and an undesirable analytic stance. This article explores recent understandings of transference and of therapeutic neutrality; the position of those relational psychoanalysts who posit that explicit use of intersubjectivity is the central treatment vehicle of psychoanalysis; and presents material from the treatment of an individual with a borderline personality disorder, using the developmental, self, and object relations approach of James Masterson, to illustrate some potential dangers of abandoning a neutral stance when treating such clients. [ABSTRACT FROM AUTHOR]

Nowadays, psychotherapy is regarded as the treatment of choice for patients with Borderline Personality Disorder(BPD). A consensus has yet to be reached, however, despite various controlled studies undertaken to determine the most suitable form of treatment. At both public and private mental health institutions, there is a growing number of BPD patients seeking treatment. These patients pose a challenge for institutional programs because their demands usually exceed the «therapeutic capacity» of conventional forms of psychiatric treatment. Due to this heavy demand, various strategies have been examined in order to treat this type of patients properly. These include short group therapy. This article presents the results of a controlled clinical study comparing the effectiveness of treatment according to the composition of the groups: a homogeneous group, consisting solely of borderline patients and another in which only half had been diagnosed with BPD while the others only had Axis 1 disorders, with no serious personality pathology. The study considered the variables of psychiatric symptomatology, quality of life, self-esteem, «ego strength», perceived social support, social adjustment and inter-personal problems. Both groups contained female subjects only. The quantitative results of the mixed group show significant changes in the psychiatric symptoms as well as the evolution of interpersonal problems and current quality of life. At the same time, the homogeneous group showed changes in the ideal quality of life and the self-esteem scale. A comparison of the base and final scores showed that the BPD group showed no reduction in psychiatric symptomatology, nor was there a positive evolution in inter-personal relations. At the same time, when other groups were compared, it was obvious that patients in the mixed group showed greater changes in interpersonal problems and depression, anxiety, paranoid and hostility symptoms. … [ABSTRACT FROM AUTHOR]

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy. [ABSTRACT FROM AUTHOR]

In borderline or even narcissistic patients, the relation to the objects is built on the basis of omnipotent control, so that those patients present difficulties related to mourning for the loss, as well as for the independence, of the objects. Their basic trait is a huge inability to recognize the separateness of others, together with an excessive use of primitive defense mechanisms, such as projective identification. Each experience that contains the danger of re-experiencing the primal separation poses an attack on the analytic setting, in order to avoid such a re-experiencing. Those attacks sometimes take the known form of acting out, whereas other times they are limited to a special use of speech, which lacks any communicational faculty and is used rather as a weapon. This special climate affects the analyst, causing specific countertransferential reactions. Nowadays, we tend to consider such a communication not mostly as an obstacle, but rather as an opportunity, allowing the analyst to comprehend the patient, through his countertransference, and create a meaning to replace the void those patients usually experience. The transference and countertransference enactments, their silent dialogues taking place in the analytic setting, are those which progressively give meaning in this primitive non verbal communication. [ABSTRACT FROM AUTHOR]

Transference-Focused Psychotherapy (TFP) is a modified psychodynamic psychotherapy, based on object relations theory of personality and psychoanalytic principles of the dynamic unconscious, the importance of tranference and counter-transference, and the reliance upon interpretation of the transference as the dominant therapeutic intervention. TFP has been shown to be effective in reducing symptoms and improving reflective function in a randomized clinical trial with borderline patients. Beyond initial symptom reduction, TFP has as a goal the integration of identity through interpretative elaboration of split off internalized representations of self and others that underlie the DSM IV-TR descriptive phenomena of borderline personality disorder. [ABSTRACT FROM AUTHOR]

This study investigated the quality and development of the therapeutic alliance as a mediator of change in schema-focused therapy (SET) and transference-focused psychotherapy (TFP) for borderline personality disorder. Seventy-eight patients were randomly allocated to 3 years of biweekly SET or TFP. Scores of both therapists and patients for the therapeutic alliance were higher in SET than in TFP. Negative ratings of therapists and patients at early treatment were predictive of dropout, whereas increasingly positive ratings of patients in the 1st half of treatment predicted subsequent clinical improvement. Dissimilarity between therapist and patients in pathological personality characteristics had a direct effect on growth of the therapeutic alliance but showed no relationship with clinical improvement. The authors conclude that the therapeutic alliance and specific techniques interact with and influence one another and may serve to facilitate change processes underlying clinical improvement in patients with borderline personality disorder. [ABSTRACT FROM AUTHOR]

Transference‐focused psychotherapy and mentalization‐based treatment are new psychoanalytic treatment forms for borderline patients. How do these forms of treatment differ and how are they alike? What interventions do they yield in clinical practice? In the past few years two methods of psychoanalytic treatment for borderline patients have been developed: transference‐focused therapy and mentalization‐based treatment. This paper explores the similarities and differences between them, with a special focus on how the different theories lead to different interventions in clinical practice. TFP takes the central problem to be the disorder in object relations, while MBT focuses on the self as agent. Further differences concern notions of the role of aggression, the presence of mental representations and the position of the therapist. Interventions formulated by therapists of both frames of reference in response to some therapy fragments differed substantially. Both theories share a desire to develop a psychoanalytical technique suitable for borderline patients, and both stress the central importance of the handling of the transference and of working in the here‐and‐now, as well as the necessity for effect research. [ABSTRACT FROM AUTHOR]

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation. [ABSTRACT FROM AUTHOR]

Abstract: Neuroscience research has deepened our understanding of the phenomenon of transference. Neural network theory has taught us that representations are created by forming, strengthening, or pruning connections between neurons. These representations are multiple and help dispel the notion of “the transference.” There are multiple transferences that come into play in varying degrees in every analysis. Similarly, real characteristics of the analyst play a major role in which representations are activated in any specific dyad of analyst and patient. Hence the constructivist notion of the analyst''s contributions to the transference are reinforced by neural network theory. Two distinct memory systems come into play in the creation of transference—both implicit declarative and implicit procedural elements can be found in the component of transference in the clinical setting. Research findings using functional neural imaging with borderline patients also suggest neural anatomical correlates of transference. Finally, neuroscience research leads to a more precise understanding of the therapeutic action of psychoanalysis and the fate of transferences. [Copyright &y& Elsevier]

Abstract: Psychotherapy of borderline patients allows us to observe that often, the intense affects, the rage and the lack of good internal objects prevent the mentalization of object relations that are confined to acting-out. Moreover, mentalization deficiency inhibits the experience of relationships with a good object in the transference, which often jeopardizes the continuation of the treatment. It is argued that these dimensions of borderline pathology can be better worked out by closely adjusting therapeutic interventions to the patient''s ability to mentalise psychological experiences, particularly with regards to positive transference. We explain our view that the capacity to mentalise in the transference a relationship with a good object is an indication of structural change. [Copyright &y& Elsevier]

Abstract: The Borderline Psychotherapy Research Project at New York Presbyterian Hospital-Weill Cornell Medical Center, headed by Drs Otto Kernberg and John Clarkin has developed and tested a treatment for Borderline Personality Disorder called Transference Focused Psychotherapy. The theory, development and empirical research for the treatment are discussed. A pre-post study and a comparison to treatment as usual both showed promising results. The structure of the randomized controlled trial that is currently underway is also discussed. [Copyright &y& Elsevier]

This paper addresses thc question of what is involved in psychodynamic counselling with borderline clients. The concept of borderline functioning or structure is explained and the technical difficulties of working in this area noted, especially in thc establishment of a working alliance. The types of transference manifestations with borderline clients arc then described, looking in particular at thc emergence of a psychotic transference. Two case examples are given of working with borderline clients, where the transference was dominated by primitive elements, provoking powerful countertransference reactions in the counsellor. How both thc client and thc counsellor can be contained in the therapeutic work is then addressed. Finally, some implications of this discussion are drawn out for the training of psychodynamic counsellors, in order to equip them best for working with borderline clients. Three features of what a training should offer arc identified: it should provide students with thc opportunity for the exploration of thc psychotic parts of their own personality; it should allow for and encourage the internalization of psychoanalysis itself as a sustaining internal object; and it should provide students with the experience of working with clients over sufficient time and at sufficient depth so they can learn about the timing and effectiveness of interventions in work with borderline clients. [ABSTRACT FROM AUTHOR]

In this paper, the main concepts of Otto Kernberg and Heinz Kohut--two theorists who have greatly influenced clinical social work practice with severely disturbed patients--are presented, and then compared by using a case from the practice of the author. The case illustrates the value of utilizing some of the treatment principles put forward by Kernberg and Kohut without becoming too wedded to either of the overall treatment approaches they have formulated. Some aspects of the manner in which the practitioner determines when the treatment approach needs to be modified--to avoid the pitfalls of either being too wedded to an approach or too eclectic--are discussed as well. [ABSTRACT FROM AUTHOR]

Discusses strategies for medical staff in addressing countertransference among borderline personality disorder patients. Recognition of the most common symptoms of countertransference; Recommendation of frequent meetings and open communication within the treatment team.

Starting from Jung's hypothesis of 'the psychoid', the author suggests that the concept can be extended and understood as a dynamic, relational and interpersonal experience-especially in regressed analytic relations. The author then defines his use of the term 'animating body' as having to do with primitive animal imagery and with psychosomatic symptoms stemming from disturbed pre-verbal and pre-whole-object stages of development. A case of a borderline patient is presented, whose projective identifications into the analyst infected him with her psychosomatic disorder, with her internalized Oedipal confusion and necessarily induced a mutually similar animal dream symbolism. If these embodied countertransference experiences (of desperate merging and sickening identification) can be lived through (tolerated and survived), thought through and interpreted, then they can actually become enlivening and lead to a therapeutic psychosomatic co-ordination. [ABSTRACT FROM AUTHOR]

Focuses on borderline personality disorders. Borderline and archetypal levels of the psyche; Difficulties emerging in the transference-countertransference; Fordham's deintegrative-reintegrative model.

After reviewing differing approaches to the treatment of the borderline patient, this paper describes the treatment of a patient whose negative transferences are not interpreted by the therapist; rather, the focus is on maintaining the therapeutic alliance via the awareness of the kinship selfobject function of the therapist and merger with the idealized selfobject. [ABSTRACT FROM AUTHOR]

Countertransference reactions of sleepiness and disinterest in the clinical material being presented by patients can be annoying and confusing. This paper presents a theoretical framework for understanding the author's countertransference with Borderline patients in the schizoid continuum of borderline pathology, according to a classification scheme from Meissner (1984). In the case example presented projective identification and several interpretations of its meaning are reviewed and linked with the author/therapist's experience of sleepiness in the session. The understanding and containment of these projections, as well as interpretations offered to the patient, allowed for a successful resolution to the treatment. Implications for other cases with similar character structure are discussed with emphasis on the therapists using their subjective experience of sleepiness to understand their patients. [ABSTRACT FROM AUTHOR]

Introduction: The countertransference of the therapist is crucial in psychotherapy. Although the concept of countertransference arose from psychoanalysis, it is considered a construct that occurs in any type of therapy. Objectives: The purpose of this review is to examinate the relationship between personality disorders and countertransference. Methods: A systematic literature review was performed on PubMed using the keywords "personality disorder" and "countertransference". All papers published between 2015 and 2020 were evaluated. Results: There were significant relationships between and patients' personality disorders and patterns of countertransference. Criticized countertransference were associated with paranoid and antisocial personality disorders. Borderline personality disorders was related to helpless, overwhelmed, and overinvolved responses. Narcissistic and schizotypal personality disorders were associated with disengaged therapist responeses. Helpless countertransference was associated with schizoid personality disorders. Avoidant personality disorders was associated with postive responses. Special/overinvolved therapist responses were associated with obsessivecompulsive personality disorders Conclusions: Several studies suggest that therapists' emotional responses occur consistently in any kind of therapy. Moreover, specific personality disorders are associated with concrete emotional responses. Therefore, therapists can make therapeutic and diagnostic use of their conuntertransference. [ABSTRACT FROM AUTHOR]

Focuses on the effectiveness of the different methods used to treat patients with borderline personality disorder. Operationalization of the therapeutic treatment; Reduction of the defensiveness on patients with borderline personality disorder; Importance of conscious understanding of transference and countertransference.

Explores the issue of reining in compassionate countertransference while treating a patient. Attempts to reveal the author's emotional reactions to patients with borderline personality disorder and especially to a particular depressed woman who wanted to commit suicide; Description of the author's interaction with the patient; List of questions related to death that were raised in the author's mind while dealing with the patient.