Primer of Transference-Focused Psychotherapy for the Borderline Patient / Edition 1

Primer of Transference-Focused Psychotherapy for the Borderline Patient / Edition 1

by Frank E. Yeomans, John F. Clarkin, Otto F. Kernberg

ISBN-10: 0765703556

ISBN-13: 9780765703552

Pub. Date: 07/01/2002

Publisher: Aronson, Jason Inc.

Treating borderline patients is one of the most challenging areas in psychotherapy because of the patient's extreme emotional expressions, the strain it places on the therapist, and the danger of the patient acting out and harming himself or the therapeutic relationship. Many clinicians consider this patient population difficult, if not impossible, to treat.

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Treating borderline patients is one of the most challenging areas in psychotherapy because of the patient's extreme emotional expressions, the strain it places on the therapist, and the danger of the patient acting out and harming himself or the therapeutic relationship. Many clinicians consider this patient population difficult, if not impossible, to treat. However, in recent years dedicated experts have focused their clinical and research efforts on the borderline patient and have produced treatments that increase our success in working with borderline patients. Transference-Focused Therapy (TFP) is psychodynamic treatment designed especially for borderline patients. This book provides a concise and comprehensive introduction to TFP that will be useful both to experienced clinicians and also to students of psychotherapy. TFP has its roots in object relations and it emphasizes that the transference is the key to understanding and producing change. The patient's internal world of object representations unfolds and is lived in the transference with the therapist. The therapist listens for and makes use of the relationship that is revealed through words, silence, or, as often occurs in the case of individuals with some borderline personality disorder, acting out in subtle or not-so-subtle ways. This primer offers clinicians a way to understand and then use the transference and countertransference for change in the patient.

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Product Details

Aronson, Jason Inc.
Publication date:
Edition description:
New Edition
Product dimensions:
6.36(w) x 9.47(h) x 0.94(d)

Table of Contents

Pt. IWho Are the Patients? Diagnostic Issues
1What is borderline personality disorder (BPD)?3
2What is the borderline personality organization (BPO) and how does it provide a broader understanding and conceptual framework than borderline personality disorder (BPD)?5
3What is identity diffusion?8
4What is reality testing?9
5What are primitive defense mechanisms?10
6What is object relations theory and how does it apply to borderline personality and transference-focused psychotherapy (TFP)?12
7How are defense mechanisms understood in terms of internalized object relations?18
8How does the development of internal psychological structure differ in normal individuals as compared to individuals with borderline personality?23
9What is psychic structure?26
10Are there circumstances in which adults who are not borderline function at a split level of psychic organization?27
11In the primitively organized split psyche, what interactions might be expected within and among the object relations dyads?28
12How does one assess for BPO and BPD?31
13What are the origins of borderline personality organization?33
Pt. IIWhat is the Essence of the Treatment?
14What is TFP?39
15What are the patient inclusion and exclusion criteria for TFP?41
16Aside from the strict exclusion criteria, are there other prognostic factors?43
17What kind of change can be expected from TFP?45
18How does TFP modify traditional psychodynamic psychotherapy to create a treatment specific to borderline patients?47
19What are the principle alternative treatments for BPD and BPO?49
Pt. IIITreatment Strategies
20What is the concept of treatment strategies?55
21What are the specific treatment strategies?57
Pt. IVTreatment Tactics
22What are the treatment tactics?67
Pt. IV-ATactic #1 - Contract Setting
23Does therapy start with the first session?71
24What constitutes an adequate evaluation?73
25Is it possible to include others, beside the patient, in the evaluation process?74
26What does the therapist say to the patient after arriving at a diagnostic impression?75
27When is the treatment contract set with the patient?79
28What therapeutic concepts underlie the treatment contract?80
29What are the universal elements of the treatment contract?86
30What are the elements of the contract that are specific to the individual patient?88
31How do I keep anxiety about the possibility of patients' killing themselves from distracting me from my work?91
32What about patients who call very frequently?95
33What calls are appropriate?96
34What is done if the patient breaks the treatment contract?97
35When and how does a therapist shift from the contract-setting phase of therapy to the therapy itself?100
36What are the most common ways therapists have to intervene to protect the treatment frame?101
37What is the concept of secondary gain and why is it important to eliminate it?103
Pt. IV-BChoosing the Priority Theme to Address
38Given the amount of data therapists are exposed to in a session, how to they decide what to address?107
39What are the economic, dynamic, and structural principles that guide the therapist's attention?108
40What are the three channels of communication?111
41What is the hierarchy of priorities with regard to material presented in a session?114
42How does the therapist use this hierarchy from moment to moment in the course of a session?116
43Which items on this list generally present a special challenge to the therapist?118
44Is there a strict separation between the addressing obstacles to therapy and the analytic work itself?120
Pt. IV-CThe Remaining Tactics
45How does the therapist maintain the balance between expanding incompatible views of reality between patient and therapist and establishing common elements of reality?125
46Why is it important to maintain an awareness of analyzing both the positive and negative aspects of the transference?131
Pt. VTreatment Techniques
47What are the techniques used in TFP?137
48What is meant by clarification in TFP?138
49What is meant by confrontation in TFP?140
50What is meant by interpretation?142
51What are the different levels of interpretation?143
52How should interpretations be delivered?148
53How does the therapist go about the transference analysis of primitive defenses?151
54What is technical neutrality and how does the therapist manage it in TFP?156
55How do therapists monitor their countertransference and integrate what they learn from it into the treatment?160
Pt. VICourse of Treatment After the Contract
56What are the phases of TFP?163
57Does treatment generally demonstrate a linear progression?164
58What are some of the early problems that may be encountered in carrying out the treatment? Early problems I - Testing the frame/contract166
59Early problems II - The meaningful communication is subtle and is in the patients' actions more than in his or her words169
60Early problems III - The therapist has difficulty with how important the therapist has become to the patient172
61How does the therapist manage affect storms?174
62What are the signs of progress in TFP?178
63What are the signs that the patient is nearing the termination of therapy and how does the therapist conceptualize and discuss termination?179
Pt. VIISome Typical Treatment Trajectories
64Is it possible to delineate some typical treatment trajectories that illustrate TFP principles as the therapy evolves?185
Pt. VIIICommon Complications of Treatment
65How does the therapist deal with the threat of the patient dropping out of treatment?213
66Are patients with childhood sexual and/or physical abuse capable of engaging in TFP?217
67Is hospitalization ever indicated in the course of treatment?220
68If the patient is hospitalized, should the therapist meet with the patient in the hospital?223
69What is the role of medications in TFP?224
70Who should prescribe the medications?229
71What are the most typical transference meanings of medication?231
72How does one handle crises around interruptions in the treatment?232
73How does the therapist deal with intense eroticized transferences?233
Pt. IXRequirements for Doing TFP
74What are the basic skills needed to do this treatment?237
75What forms and levels of supervision are necessary/advisable?241
Pt. XPractical Questions in Delivering the Treatment
76How does one get consultation on the TFP treatment of BPO patients or organize a supervision group?245
77How does one cover these patients when the therapist is away?246
78What if I work in a clinic that does not support twice-a-week therapy?247
79Is there empirical data to show that TFP is effective?248
A Final Note253

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