Psychotherapy for Borderline Personality : Focusing on Object Relations by John F. Clarkin, Frank E. Yeomans, Otto F. Kernberg.— 1st ed. pdf

This book is the product of more than 25 years of treatment development by a team of theoreticians, clinicians, and researchers exploring ways to refine a psychotherapy intervention for individuals with severe personality disorders. The dominant focus of most psychotherapy and pharmacological efforts today is geared to the short-term treatment of symptoms. In contrast, we are interested in the treatment of individuals who have symptoms, but whose symptoms reside in the context of abnormal development and personality.

Therefore, we seek to explore the theory and data on the development of personality, both normal personality and its variations. The treatment we have been developing has the ambitious goal of not just changing symptoms but of changing the personality that is at the root of the symptoms, and consequently the quality of life of die individual.

Although we have a psychodynamic, object relations orientation, we were intent on developing a treatment—not just adapting existing psychodynamic treatments—that effectively targets the pathology of character. In that process, we have utilized the growing research and theoretical advances in the clinical and research communities of today. Most helpful were advances in object relations theory and attachment theory. Our aim was to combine theory, experience, and data in a treatment development approach that acquired information and changed the treatment accordingly.

There has emerged in the psychotherapy research world the idea of a manual (Clarkin 1998) that describes in written form a psychotherapeutic treatment in enough detail that clinicians at various sites can administer the same treatment. In experimental research, it is imperative that the independent variable (in this case, the form of treatment) is objectified and uniform, in order to examine its impact on the dependent variables (patient improvement). Thus a large number of psychotherapy treatment manuals have been written that describe cognitive-behavioral, interpersonal, and psychody-namic treatments (see Caligor, in press) that are to be delivered over a brief period of time, often focused on a specific patient population homogeneous for a specific symptom complex (e.g., depression). From a research point of view, the greater the relative degree of specificity in the manual, and the lesser the variability among die different therapists, the better. Clinicians have often objected to die manualization process as one in which the intuition of die individual clinician was sacrificed for the sake of clarity and uniformity in the research. Clinicians sometimes perceived the manuals as stifling their creativity and use of intuition rather than enhancing their skills.

To the degree that this book is a manual of psychodynamic therapy, it is similar to but quite different from most manuals that have been published. When treatment goes beyond a brief duration of some 12-15 sessions, it Is impossible to describe and proscribe in detail what will happen in each session. To the degree that one is treating more disturbed patients who often act rather dian talk and are more inclined to disrupt the flow of the session, uniformity gives way to many unexpected moments between patient and therapist. We fully acknowledge that in a treatment of a year or longer with borderline patients, many unexpected and unanticipated events wull arise, events for which no treatment manual can specify exactly what the therapist should do.

Therefore, this is a treatment manual that describes principles of intervention with borderline patients and does not pretend or aspire to cover every conceivable event between patient and therapist or the exact order in which treatment will proceed. The principles of intervention guide the therapist, as opposed to manuals in which the actions of the therapist arc predetermined session by session. The principles of transference-focused psychotherapy (TFP) are embodied in the strategies, tactics, and techniques that we describe in this book.

This updated volume also profits from our growing experience in several other ways. We have had more experience in transporting TFP to clinical sites other than our own. That experience has helped us to expand our teaching tools and has provided us with a view of how TFP is used in diverse cultural settings. We have now had more research experience in assessing the impact of TFP on our patients. These research findings help us identify more precisely the course and type of changes resulting from TFP.

Psychotherapy and its near neighbor psychotherapy research aspire to scientific status. We have participated in that endeavor, and the results of our data collection are reflected in this volume. However, one must simultaneously realize that psychotherapy is a craft—an enterprise that is done by craftsmen who work with the patient to effect deep change in the patient’s life without always operating from clear, precise, scientific guidelines.

Contents

• The Nature of Borderline Personality Organization
• Treatment of Borderline Pathology: The Strategies of Transference-Focused  Psychotherapy
• Techniques of Treatment: The Moment-to-Moment Interventions
• Tactics of Treatment: Laying the Foundation for the Techniques
• Assessment Phase, I: Clinical Evaluation and Treatment Selection
• Assessment Phase, II: Treatment Contracting
• Early Treatment Phase: Tests of the Frame and Impulse Containment
• Midphase of Treatment: MovementToward Integration With Episodes of  Megression
• Advanced Phase of Treatment and Termination
• Common Treatment Complications
• Change Processes in Transference-Focused
• Psychotherapy: Theoretical and Empirical Approaches

Language: English
Format: PDF
Pages: 205
Size: 25.4 mb
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