| |
| |
| 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 | |