Psychotherapy With Borderline Patients


Book Description

Patients with borderline personality disorder (BPD) or borderline traits are among the most difficult for mental health practitioners to treat. They present an incredible range of symptoms, dysfunctional interpersonal interactions, provocative behavior in therapy, and comorbid psychiatric disturbances. So broad is this array that indeed the disorder constitutes a virtual model for the study of all forms of self-destructive and self-defeating behavior patterns. Psychotherapy With Borderline Patients: An Integrated Approach fills the need for a problem-focused, clinically oriented, and operationalized treatment manual that addresses major ongoing family factors that trigger and reinforce the patient's self-destructive or self-defeating behavior. In it, David Allen draws on the theoretical ideas and techniques of biological, family systems, psychodynamic, and cognitive-behavioral therapists to describe an integrated approach to adults with BPD or borderline traits in individual therapy. Innovative, practical, and specific, the book * helps therapists teach their patients, through the use of various role-playing techniques, strategies to alter the dysfunctional patterns of interaction with their families of origin that reinforce self-destructive behavior or chronic affective symptoms; * explains the nature and origins of the characteristic oscillation of hostile over- and underinvolvement between adults with BPD and those who served as their primary parental figures during childhood; * elucidates the nature and causes of the dysfunctional communication patterns in patients' families that lead to misunderstanding; and * provides concrete, clearly spelled out advice for therapists about how to deal with provocative patient behavior, how to minimize distorted descriptions by patients of significant others, how to avoid patients' misuse of medications, and how to respond to managed care restrictions on patients' insurance coverage. Psychotherapy With Borderline Patients: An Integrated Approach will be welcomed by all clinicians who work with these patients, whatever their training or theoretical orientation.




Transference-Focused Psychotherapy for Borderline Personality Disorder


Book Description

Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide presents a model of borderline personality disorder (BPD) and its treatment that is based on contemporary psychoanalytic object relations theory as developed by the leading thinker in the field, Otto Kernberg, M.D., who is also one of the authors of this insightful manual. The model is supported and enhanced by material on current phenomenological and neurobiological research and is grounded in real-world cases that deftly illustrate principles of intervention in ways that mental health professionals can use with their patients. The book first provides clinicians with a model of borderline pathology that is essential for expert assessment and treatment planning and then addresses the empirical underpinnings and specific therapeutic strategies of transference-focused psychotherapy (TFP). From the chapter on clinical assessment, the clinician learns how to select the type of treatment on the basis of the level of personality organization, the symptoms the patient experiences, and the areas of compromised functioning. In order to decide on the type of treatment, the clinician must examine the patient's subjective experience (such as symptoms of anxiety or depression), observable behaviors (such as investments in relationships and deficits in functioning), and psychological structures (such as identity, defenses, and reality testing). Next, the clinician learns to establish the conditions of treatment through negotiating a verbal treatment contract or understanding with the patient. The contract defines the responsibilities of each of the participants and defines what the reality of the therapeutic relationship is. Techniques of treatment interventions and tactics to address particularly difficult clinical challenges are addressed next, equipping the therapist to employ the four primary techniques of TFP (interpretation, transference analysis, technical neutrality, and use of countertransference) and setting the stage for and guiding the proper use of those techniques within the individual session. What to expect in the course of long-term treatment to ameliorate symptoms and to effect personality change is covered, with sections on the early, middle, and late phases of treatment. This material prepares the clinician to deal with predictable phases, such as tests of the frame, impulse containment, movement toward integration, episodes of regression, and termination. Finally, the text is accompanied by supremely instructive online videos that demonstrate a variety of clinical situations, helping the clinician with assessment and modeling critical therapeutic strategies. The book recognizes that each BPD patient presents a unique treatment challenge. Grounded in the latest research and rich with clinical insight, Transference-Focused Psychotherapy for Borderline Personality Disorder: A Clinical Guide will prove indispensable to mental health professionals seeking to provide thoughtful, effective care to these patients.




Psychotherapy for Borderline Personality Disorder


Book Description

Borderline Personality disorder is a severe personality dysfunction characterized by behavioural features such as impulsivity, identity disturbance, suicidal behaviour, emptiness, and intense and unstable relationships. Approximately 2% of the population are thought to meet the criteria for BPD. The authors of this volume - Anthony Bateman and Peter Fonagy - have developed a psychoanalytically oriented treatment to BPD known as mentalization treatment. With randomised controlled trialshaving shown this method to be effective, this book presents the first account of mentalization treatment for BPD. The first section gives an overview of BPD, including discussion of nosology, epidemiology, natural history, and psychosocial aetiology. It additionally summarises the present state of our research knowledge about effective psychotherapeutic treatments and use of medication. The second section outlines the authors' theoretical approach and contrasts it with other well known methods, including DBT, CAT, and CBT. In the extensive final section, the authors outline their clinical approach starting with how treatment is organised. A detailed account of the transferable features of the model is provided along with the main strategies and techniques of treatment. Numerous clinical examples are given to illustrate the core techniques and detailed information provided about how to apply aspects of the mentalization based treatment approach in everyday practice. Aimedat mental health professionals, along with counsellors, psychotherapists, and psychoanalysts, the book will be a valuable tool, providing an effective means of treating those suffering from Borderline Personality Disorder.




A Primer of Transference-focused Psychotherapy for the Borderline Patient


Book 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 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.




Becoming a Constant Object in Psychotherapy with the Borderline Patient


Book Description

1. standing still 2. The state of the art 3. major issues in treatment of the borderline patient 4. perpetual fear and abandonment 5. inability to modulate affect 6. intolerance of separateness 7. adaptive matrix constancy 8. differentiating constancy 9. reparation constancy.




Borderline Patients: Extending The Limits Of Treatability


Book Description

1. Borderline patients and transference focused psychotherapy 2. factors that shape borderline personality disorder 3. treatment dilemmas arising from misdiagnoses 4. sadomasochism 5. narcissism and psychopathy 6. the impact of attachment status 7. schizoid states and paranoid regression 8. depression and suicidality 9. trauma, sexual pathology, and acting out 10. erotic transference and countertransference 11. using dream material 12. transference focused psychotherapy combined with parmacotherapy 13. transference focused psychotherapy in sequence with other modalities.




Management of Countertransference with Borderline Patients


Book Description

Management of Countertransference with Borderline Patients is an open and detailed discussion of the emotional reactions that clinicians experience when treating borderline patients. This book provides a systematic approach to managing countertransference that legitimizes the therapist's reactions and shows ways to use them therapeutically with the patient.




Psychotherapy of the Quiet Borderline Patient


Book Description

The as-if patient very often comes to treatment at the behest of someone else, or comes with only the vaguest sense that something is wrong, hence, the patient does not usually notice that nothing is happening in therapy.




Supportive Therapy for Borderline Patients


Book Description

``I have become convinced that many borderline patients are not helped by the psychiatric treatment they receive and even more troubling, that a fair percentage of them are made worse by it....Dr. Rockland's approach makes sense to me at a time when much of the literature on the psychotherapy of borderline personality does not....I have learned a great deal from this book and feel confident that it will have a pronounced beneficial effect on clinical practice.' --From the Foreword by Allen J. Frances Noting the potential dangers of uncovering approaches, early writers on borderline personality emphasized the value of supportive therapy. Despite these warnings, the preponderance of the current literature on borderline disorder is confined to exploratory psychotherapy and psychoanalysis. Redressing this imbalance in the literature, this important new work is the first to present an organized and detailed description of how supportive interventions are accomplished with borderline patients. With a uniquely practical focus on ``how to do it,' Lawrence H. Rockland applies the principles of Psychodynamically Oriented Supportive Therapy (POST)--an approach that he formulated--to patients with Borderline Personality Disorder (BPD). Divided in three sections, the book's opening chapters review the changing concepts of the borderline, vicissitudes in treatment recommendations, the general principles of POST, and the indications for applying this approach to BPD. The second section presents the 2 1/2-year psychodynamic supportive treatment of a patient with BPD. The four phases of treatment--evaluation and treatment planning, early phase, middle phase, and termination--are discussed in detail and illustrated with session dialogue and critical commentary by the author. The final section addresses two major problems--therapist countertransference and patient acting out. Other topics include continuous/intermittent supportive therapy, psychopharmacology in supportive therapy, and supportive aspects of inpatient treatments. Filling a significant gap in the literature, this important new volume's systematic and comprehensive exposition of supportive therapy for borderline patients makes it an invaluable resource for all practitioners who work with this difficult population. Replete with clinically useful suggestions and guidelines, it is ideal for trainees in all mental health disciplines. It is relevant to any course on dynamic psychotherapy, and serves as a text for all students of borderline pathology and its treatment.




Psychodynamic Psychotherapy Of Borderline Patients


Book Description

This long-awaited book is the first to present Otto Kernberg's successful model of psychodynamic psychotherapy with borderline patients. Using abundant clinical vignettes and transcripts, the authors take the reader through the treatment--from establishing contact to dealing with termination--always explaining the theory that underlies the technique. Bibliography and Index.