Primer of Transference-Focused Psychotherapy for the Borderline Patient

ISBN-10: 0765703556
ISBN-13: 9780765703552
Edition: 2002
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Description: 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  More...

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Book details

List price: $89.00
Copyright year: 2002
Publisher: Rowman & Littlefield Publishers, Incorporated
Publication date: 7/31/2002
Binding: Hardcover
Pages: 284
Size: 6.25" wide x 9.00" long x 1.25" tall
Weight: 1.386
Language: English

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.

Mark F. Lenzenweger, PhD, is Professor of Clinical Science, Cognitive Psychology, and Behavioral Neuroscience in the Department of Psychology at the State University of New York (SUNY) at Binghamton and Adjunct Professor of Psychology in Psychiatry at the Weill Medical College of Cornell University, New York City. He also directs the Laboratory of Experimental Psychopathology at SUNY/n-/Binghamton, where he conducts research and teaches on personality disorders, schizophrenia, schizotypy, and statistical methods. John F. Clarkin, PhD, is Professor of Clinical Psychology in Psychiatry at the Weill Medical College of Cornell University and Director of Psychology and Co-Director of the Personality Disorders Institute at New York/n-/Presbyterian Hospital. His academic writing and research have focused on the phenomenology of the personality disorders and the treatment of patients with borderline personality disorder.

Preface
Who Are the Patients? Diagnostic Issues
What is borderline personality disorder (BPD)?
What is the borderline personality organization (BPO) and how does it provide a broader understanding and conceptual framework than borderline personality disorder (BPD)?
What is identity diffusion?
What is reality testing?
What are primitive defense mechanisms?
What is object relations theory and how does it apply to borderline personality and transference-focused psychotherapy (TFP)?
How are defense mechanisms understood in terms of internalized object relations?
How does the development of internal psychological structure differ in normal individuals as compared to individuals with borderline personality?
What is psychic structure?
Are there circumstances in which adults who are not borderline function at a split level of psychic organization?
In the primitively organized split psyche, what interactions might be expected within and among the object relations dyads?
How does one assess for BPO and BPD?
What are the origins of borderline personality organization?
What is the Essence of the Treatment?
What is TFP?
What are the patient inclusion and exclusion criteria for TFP?
Aside from the strict exclusion criteria, are there other prognostic factors?
What kind of change can be expected from TFP?
How does TFP modify traditional psychodynamic psychotherapy to create a treatment specific to borderline patients?
What are the principle alternative treatments for BPD and BPO?
Treatment Strategies
What is the concept of treatment strategies?
What are the specific treatment strategies?
Treatment Tactics
What are the treatment tactics?
Tactic #1 - Contract Setting
Does therapy start with the first session?
What constitutes an adequate evaluation?
Is it possible to include others, beside the patient, in the evaluation process?
What does the therapist say to the patient after arriving at a diagnostic impression?
When is the treatment contract set with the patient?
What therapeutic concepts underlie the treatment contract?
What are the universal elements of the treatment contract?
What are the elements of the contract that are specific to the individual patient?
How do I keep anxiety about the possibility of patients' killing themselves from distracting me from my work?
What about patients who call very frequently?
What calls are appropriate?
What is done if the patient breaks the treatment contract?
When and how does a therapist shift from the contract-setting phase of therapy to the therapy itself?
What are the most common ways therapists have to intervene to protect the treatment frame?
What is the concept of secondary gain and why is it important to eliminate it?
Choosing the Priority Theme to Address
Given the amount of data therapists are exposed to in a session, how to they decide what to address?
What are the economic, dynamic, and structural principles that guide the therapist's attention?
What are the three channels of communication?
What is the hierarchy of priorities with regard to material presented in a session?
How does the therapist use this hierarchy from moment to moment in the course of a session?
Which items on this list generally present a special challenge to the therapist?
Is there a strict separation between the addressing obstacles to therapy and the analytic work itself?
The Remaining Tactics
How does the therapist maintain the balance between expanding incompatible views of reality between patient and therapist and establishing common elements of reality?
Why is it important to maintain an awareness of analyzing both the positive and negative aspects of the transference?
Treatment Techniques
What are the techniques used in TFP?
What is meant by clarification in TFP?
What is meant by confrontation in TFP?
What is meant by interpretation?
What are the different levels of interpretation?
How should interpretations be delivered?
How does the therapist go about the transference analysis of primitive defenses?
What is technical neutrality and how does the therapist manage it in TFP?
How do therapists monitor their countertransference and integrate what they learn from it into the treatment?
Course of Treatment After the Contract
What are the phases of TFP?
Does treatment generally demonstrate a linear progression?
What are some of the early problems that may be encountered in carrying out the treatment? Early problems I - Testing the frame/contract
Early problems II - The meaningful communication is subtle and is in the patients' actions more than in his or her words
Early problems III - The therapist has difficulty with how important the therapist has become to the patient
How does the therapist manage affect storms?
What are the signs of progress in TFP?
What are the signs that the patient is nearing the termination of therapy and how does the therapist conceptualize and discuss termination?
Some Typical Treatment Trajectories
Is it possible to delineate some typical treatment trajectories that illustrate TFP principles as the therapy evolves?
Common Complications of Treatment
How does the therapist deal with the threat of the patient dropping out of treatment?
Are patients with childhood sexual and/or physical abuse capable of engaging in TFP?
Is hospitalization ever indicated in the course of treatment?
If the patient is hospitalized, should the therapist meet with the patient in the hospital?
What is the role of medications in TFP?
Who should prescribe the medications?
What are the most typical transference meanings of medication?
How does one handle crises around interruptions in the treatment?
How does the therapist deal with intense eroticized transferences?
Requirements for Doing TFP
What are the basic skills needed to do this treatment?
What forms and levels of supervision are necessary/advisable?
Practical Questions in Delivering the Treatment
How does one get consultation on the TFP treatment of BPO patients or organize a supervision group?
How does one cover these patients when the therapist is away?
What if I work in a clinic that does not support twice-a-week therapy?
Is there empirical data to show that TFP is effective?
A Final Note
Index

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