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

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Overview

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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Editorial Reviews

PsycCRITIQUES
A Primer of Transference-Focused Psychotherapy for the Borderline Patient provides an excellent introduction and resource guide for object-relations therapy for these [borderline] patients.
This is an excellent introductory and reference source for object-relations therapy with borderline patients. It is user-friendly and practical in its discussions of theory, technique, and long-term considerations for ethical and therapeutic pitfalls. An abundance of resource and bibliographic references are provided to direct the reader to more in-depth discussions of the key topics. The text provides a road map for the budding therapist when encountering splitting, therapeutic boundaries, and threats to the treatment contract. Excellent examples are provided to illustrate the identification of negative object dyads and ways they are manifest in transference material.
Elizabeth L. Auchincloss
In this remarkable volume, Yeomans, Clarkin, and Kernberg have accomplished the impossible by combining a highly sophisticated theory of psychopathology and technique with a practical handbook for the treatment of borderline patients. The reader will find here a concise review of a psychoanalytic approach to understanding borderline personality organization. The clinician will also find a detailed step-by-step guide to the complex process of turning the emotionally intense and often chaotic interactions generated by these patients into useful psychotherapeutic dialogue. While this book presents itself as A Primer of Transference-Focused Psychotherapy for the Borderline Patient, it has much to offer psychodynamic psychotherapists at all levels of experience in their treatment of patients at all levels of personality organization.
Peter Fonagy
Yeomans, Clarkin, and Kernberg's A Primer of Transference-Focused Psychotherapy for the Borderline Patient stands out like a beacon to the rest of the psychodynamic community. In an era of empirically supported therapies, the work of the Cornell group has shown that it can be done, that it can be done superbly, and that it can be done without violating a single one of our cherished ideals as psychoanalytic clinicians. This is an excellent and immensely helpful introduction to the most successful program of intervention research on psychodynamic psychotherapy anywhere. It is a must-have.
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Product Details

  • ISBN-13: 9780765703552
  • Publisher: Aronson, Jason Inc.
  • Publication date: 7/1/2002
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 284
  • Sales rank: 1,002,410
  • Product dimensions: 6.36 (w) x 9.47 (h) x 0.94 (d)

Meet the Author

Frank E. Yeomans, M.D., Ph.D., is Clinical Associate Professor of Psychiatry at the Weill Medical College of Cornell University and Co-Director of Training and Senior Supervisor at the Personality Disorders Institute at the New York Presbyterian Hospital, Westchester Division. In addition to private practice in New York City and White Plains, NY, Dr. Yeomans teaches and supervises Transference-Focused Psychother-apy in Quebec, the Netherlands, Switzerland, and Germany. John F. Clarkin, Ph.D., is a Professor of Clinical Psychology, Department of Psychiatry at the Weill Medical College of Cornell University and the Co-Director of the Personality Disorders Institute and the Director of Psychology at Cornell Medical Center. Dr. Clarkin is on the Research Faculty and is a Lecturer at Columbia University's Psychoanalytic Center. His research publications are on the phenomenology of personality disorders, especially borderline personality disorder. For the last twelve years, he has directed a large scale clinical study of the effect of psychodynamic psychotherapy with severely disturbed borderline personality disorder patients. Otto F. Kernberg, M.D., F.A.P.A., is Director of the Personality Disorders Institute at The New York Presbyterian Hospital, Westchester Division and Professor of Psychiatry at the Weill Medical College of Cornell University. Dr. Kernberg is Past President of the International Psychoanalytic Association and also Training and Supervising Analyst of the Columbia University Center for Psychoanalytic Training and Research. From 1976 to 1995 he was Associate Chairman and Medical Director of The New York Hospital-Cornell Medical Center, Westchester Division. He was elected Doctor Honoris Causa by the University of Buenos Aires, Argentina, in 1998, and received the 1999 Austrian Cross of Honor for Science and Art.

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Table of Contents

Preface
Pt. I Who Are the Patients? Diagnostic Issues
1 What is borderline personality disorder (BPD)? 3
2 What is the borderline personality organization (BPO) and how does it provide a broader understanding and conceptual framework than borderline personality disorder (BPD)? 5
3 What is identity diffusion? 8
4 What is reality testing? 9
5 What are primitive defense mechanisms? 10
6 What is object relations theory and how does it apply to borderline personality and transference-focused psychotherapy (TFP)? 12
7 How are defense mechanisms understood in terms of internalized object relations? 18
8 How does the development of internal psychological structure differ in normal individuals as compared to individuals with borderline personality? 23
9 What is psychic structure? 26
10 Are there circumstances in which adults who are not borderline function at a split level of psychic organization? 27
11 In the primitively organized split psyche, what interactions might be expected within and among the object relations dyads? 28
12 How does one assess for BPO and BPD? 31
13 What are the origins of borderline personality organization? 33
Pt. II What is the Essence of the Treatment?
14 What is TFP? 39
15 What are the patient inclusion and exclusion criteria for TFP? 41
16 Aside from the strict exclusion criteria, are there other prognostic factors? 43
17 What kind of change can be expected from TFP? 45
18 How does TFP modify traditional psychodynamic psychotherapy to create a treatment specific to borderline patients? 47
19 What are the principle alternative treatments for BPD and BPO? 49
Pt. III Treatment Strategies
20 What is the concept of treatment strategies? 55
21 What are the specific treatment strategies? 57
Pt. IV Treatment Tactics
22 What are the treatment tactics? 67
Pt. IV-A Tactic #1 - Contract Setting
23 Does therapy start with the first session? 71
24 What constitutes an adequate evaluation? 73
25 Is it possible to include others, beside the patient, in the evaluation process? 74
26 What does the therapist say to the patient after arriving at a diagnostic impression? 75
27 When is the treatment contract set with the patient? 79
28 What therapeutic concepts underlie the treatment contract? 80
29 What are the universal elements of the treatment contract? 86
30 What are the elements of the contract that are specific to the individual patient? 88
31 How do I keep anxiety about the possibility of patients' killing themselves from distracting me from my work? 91
32 What about patients who call very frequently? 95
33 What calls are appropriate? 96
34 What is done if the patient breaks the treatment contract? 97
35 When and how does a therapist shift from the contract-setting phase of therapy to the therapy itself? 100
36 What are the most common ways therapists have to intervene to protect the treatment frame? 101
37 What is the concept of secondary gain and why is it important to eliminate it? 103
Pt. IV-B Choosing the Priority Theme to Address
38 Given the amount of data therapists are exposed to in a session, how to they decide what to address? 107
39 What are the economic, dynamic, and structural principles that guide the therapist's attention? 108
40 What are the three channels of communication? 111
41 What is the hierarchy of priorities with regard to material presented in a session? 114
42 How does the therapist use this hierarchy from moment to moment in the course of a session? 116
43 Which items on this list generally present a special challenge to the therapist? 118
44 Is there a strict separation between the addressing obstacles to therapy and the analytic work itself? 120
Pt. IV-C The Remaining Tactics
45 How does the therapist maintain the balance between expanding incompatible views of reality between patient and therapist and establishing common elements of reality? 125
46 Why is it important to maintain an awareness of analyzing both the positive and negative aspects of the transference? 131
Pt. V Treatment Techniques
47 What are the techniques used in TFP? 137
48 What is meant by clarification in TFP? 138
49 What is meant by confrontation in TFP? 140
50 What is meant by interpretation? 142
51 What are the different levels of interpretation? 143
52 How should interpretations be delivered? 148
53 How does the therapist go about the transference analysis of primitive defenses? 151
54 What is technical neutrality and how does the therapist manage it in TFP? 156
55 How do therapists monitor their countertransference and integrate what they learn from it into the treatment? 160
Pt. VI Course of Treatment After the Contract
56 What are the phases of TFP? 163
57 Does treatment generally demonstrate a linear progression? 164
58 What are some of the early problems that may be encountered in carrying out the treatment? Early problems I - Testing the frame/contract 166
59 Early problems II - The meaningful communication is subtle and is in the patients' actions more than in his or her words 169
60 Early problems III - The therapist has difficulty with how important the therapist has become to the patient 172
61 How does the therapist manage affect storms? 174
62 What are the signs of progress in TFP? 178
63 What are the signs that the patient is nearing the termination of therapy and how does the therapist conceptualize and discuss termination? 179
Pt. VII Some Typical Treatment Trajectories
64 Is it possible to delineate some typical treatment trajectories that illustrate TFP principles as the therapy evolves? 185
Pt. VIII Common Complications of Treatment
65 How does the therapist deal with the threat of the patient dropping out of treatment? 213
66 Are patients with childhood sexual and/or physical abuse capable of engaging in TFP? 217
67 Is hospitalization ever indicated in the course of treatment? 220
68 If the patient is hospitalized, should the therapist meet with the patient in the hospital? 223
69 What is the role of medications in TFP? 224
70 Who should prescribe the medications? 229
71 What are the most typical transference meanings of medication? 231
72 How does one handle crises around interruptions in the treatment? 232
73 How does the therapist deal with intense eroticized transferences? 233
Pt. IX Requirements for Doing TFP
74 What are the basic skills needed to do this treatment? 237
75 What forms and levels of supervision are necessary/advisable? 241
Pt. X Practical Questions in Delivering the Treatment
76 How does one get consultation on the TFP treatment of BPO patients or organize a supervision group? 245
77 How does one cover these patients when the therapist is away? 246
78 What if I work in a clinic that does not support twice-a-week therapy? 247
79 Is there empirical data to show that TFP is effective? 248
A Final Note 253
Index 271
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